Oxalate and Dry Eye Disease; Oxalates and POTS

Recently a beloved patient asked if her history of high oxalates in her urine (normal 6.8-101; hers was 214) [lactic acid was<48, hers 284], was related to her chronic severe dry eye disease and meibomian gland dysfunction, and her relatively recent diagnosis of POTS (Postural Orthostatic Hypotension). She noted that recently she felt as if she could feel shards of sharp-something in her eyelids as she rubbed her fingers over her eyelids to try to milk the oil out of her meibomian glands as her eye has been recently more painful during a movie viewing recently.

Currently, there are no articles on Oxalates are Meibomian Glands. There are very few articles that I could find of anyone looking for oxalate in the eyelid for any reason except the article on AIDS patients below.**

I am not sure if her high oxalate and lactic acid is the cause of her dry eye pain or POTS but it may be a factor for increased inflammation. Likely eating foods to decrease her oxalate level will help.

Oxalate (IUPAC: ethanedioate) is the dianion with the formula C
, also written (COO)2−
. Either name is often used for derivatives, such as salts of oxalic acid, for example sodium oxalate Na2C2O4, or dimethyl oxalate ((CH3)2C2O4). Oxalate also forms coordination compounds where it is sometimes abbreviated as ox.

Oxalate occurs in many plants, where it is synthesized by the incomplete oxidation of carbohydrates.

The highly insoluble iron(II) oxalate appears to play a major role in gout, in the nucleation and growth of the otherwise extremely soluble sodium urate. This explains why gout usually appears after age 40[citation needed], when ferritin levels in blood exceed 1 μg/L[citation needed]. Foods high in oxalate[32] should be avoided by people suffering from, or at risk of gout.[33]

The New England Journal of Medicine reported acute oxalate nephropathy “almost certainly due to excessive consumption of iced tea” in a 56-year-old man, who drank “sixteen 8-ounce glasses of iced tea daily” (roughly 3.8 liters). The authors of the paper hypothesized that acute oxalate nephropathy is an underdiagnosed cause of kidney failure and suggested thorough examination of patient dietary history in cases of unexplained kidney failure without proteinuria (an excess of protein in the urine) and with large amounts of calcium oxalate in urine sediment.[39] 

Some preliminary evidence indicates the administration of probiotics can affect oxalic acid excretion rates in a positive manner.[38]

What Foods are High in Oxalates:
Oxalate-rich plants include fat hen (“lamb’s quarters”), sorrel, and several Oxalis species. The root and/or leaves of rhubarb and buckwheat are high in oxalic acid.[28] Other edible plants that contain significant concentrations of oxalate include, in decreasing order, star fruit (carambola), black pepperparsleypoppy seed, amaranthspinachchardbeetscocoachocolate, most nuts, most berriesfishtail palms, New Zealand spinach (Tetragonia tetragonioides), and beans.[citation needed] Leaves of the tea plant (Camellia sinensis) contain among the greatest measured concentrations of oxalic acid relative to other plants. However, the beverage derived by infusion in hot water typically contains only low to moderate amounts of oxalic acid due to the small mass of leaves used for brewing.

1. https://en.wikipedia.org/wiki/Oxalate
2. https://www.allergylink.co.uk/allergy-blog/2016/10/26/oxalate-sensitivity/#:~:text=High%20oxalate%20foods%20can%20trigger,of%20calcium%20oxalate%20kidney%20stones.

Oxalate Sensitivity

Allergy Blog
Oxalate Sensitivity
Oxalates & Oxalic Acid
and its acid form oxalic acid are organic acids that are primarily from three

Diet & food, Fungus such as aspergillus, penicillium and candida, and also
from human metabolism; bacteria produce Oxalates from the oxidation of
acid is the most acidic organic acid in body fluids and is used commercially to
remove rust from car radiators. Substances like antifreeze (ethylene glycol) is
toxic primarily because it is converted to oxalate. Oxalates may also function
as chelating agents and may chelate many toxic metals such as mercury and lead.
Unlike other chelating agents, oxalates trap heavy metals in the tissues.
acid undergoes many conversions depending on the acidity of the environment in
which it is present. Cooking has a relatively small impact on the oxalate
content of foods. However, plant foods containing oxalic acid should not be
cooked in un-coated copper, iron or aluminium pot or pan because the oxalic
acid will react with the metal ions and turn foods bad. When using aluminium,
the acids in this food may allow potentially toxic quantities of aluminium ions
to leach from the cookware. Oxalic Acid also chemically blocks Iron and Calcium
absorption by the body.
High oxalate foods can trigger pain and inflammation.

Oxalates may cause or increase inflammation, pain, burning sensations, eye and
skin irritation, irritate tissues and mucous membranes, and most importantly contributes
to the formation of calcium oxalate kidney stones.
Oxalic acid is a poison

It can cause a range of potentially life-threatening symptoms. Possible signs
of oxalic acid poisoning: abdominal pain, convulsions, kidney problems, low
blood pressure, mouth and throat pain, shock, tremors, vomiting and weak pulse.
First aid treatment includes drinking water or milk. Seek emergency care if
these symptoms appear suddenly.
Low Oxalate Diet (LOD)

Following conditions and symptoms that can be helped or cured by a low oxalate
diet: Autism spectrum disorders (ASD), chronic candida, chronic fatigue, COPD
Chronic obstructive pulmonary disease, asthma, cystic fibrosis, fibromyalgia,
hormonal imbalances, insomnia, join pain, kidney stones, thyroid disease,
urinary pain. Oxalates control is a major new factor in autism therapy.
for the vast majority of individuals who have not experienced the specific
problems described above, oxalate-containing foods should not be a health
Foods High in Oxalate 

The foods below are likely to contain more than 10 mg oxalate
per serving.

– Amaranth

– Buckwheat

– Cereal (bran or high fiber

– Crisp bread (rye or wheat)

– Quinoa

– Wheat bran

– Wheat germ

– Whole wheat bread

– Whole wheat flour

– Soy beans

– Soy milk, yogurt

– Tofu

– Dark or “robust” beer

– Black tea

– Instant coffee

– Juice from high oxalate fruits

Nuts & Seeds

– Almonds

– Cashew

– Peanuts

– Pecan

– Nuts

– Nut butters

– Sesame seeds

– Black pepper (more than 1 tsp.)

– Marmalade

– Soy sauce

– Cocoa

– Chocolate

– Parsley

– Chocolate milk

– Blackberries

– Blueberries

– Concord grapes

– Currents

– Dewberries

– Elderberries

– Figs

– Gooseberry

– Kiwis

– Lemon peel

– Orange peel

– Raspberries

– Rhubarb

– Canned strawberries

– Tamarillo

– Tangerines

– Beans (All forms)

– Beets, Beet greens

– Beet root

– Carrots

– Celery

– Chicory

– Collards

– Courgette / Zucchini

– Dandelion greens

– Aubergine / Eggplant

– Kale

– Leeks

– Okra

– Olives

– Parsley

– Peppers (chili and green)

– Potatoes (baked, boiled, fried)

– Spinach

– Sorrel

– Summer squash

– Sweet potato

– Swiss chard

though Oxalate is not an allergen or known to cause allergies, they can play a
role in some health conditions, as they may trigger or worsen symptoms. Oxalate
Sensitivity has been included under ‘Associated Links’ in the Complex 250 /
Digestion 300 and Comprehensive 500 items tests, to support people on
their search for answers to their health problems.

Other issues with Lactic Acid: is it helpful or not?

Not sure, but this short abstract from Japan is interesting:

2017 Mar;121(3):232-48.

[Anti-Aging Approach for Ocular Disorders: From Dry Eye to Retinitis Pigmentosa and Myopia]

[Article in Japanese]
  • PMID: 30088407


More than 90% of ocular diseases, such as glaucoma, age-related macular degeneration, and dry eye, are age-related with the incidence increasing with age. Furthermore, although retinitis pigmentosa and myopia may be associated with hereditary factors, they are also considered age-related diseases since they progress with aging. Thus, instead of targeting individual diseases, a new approach aimed at targeting aging itself is being examined. The most established current anti-aging approach is calorie restriction, considered to induce various gene expressions such as anti-oxidative enzymes contributing to life extension. At first, we confirmed that conditions under increased oxidative stresses, including genetically modified animals, such as Sod-1 knockout mice (KO), Mev1 transgenic mice, and Nrf-2 KO mice, and smoking induces a decrease in tear secretion resulting in dry eye. Recently, we found that dietary supplements containing lactoferrin or lactic acid bacteria suppress oxidative stress in the lacrimal glands, these results need to be considered in association with the current advances in the microbiome research. It is now possible to promote the clinical use of those supplements to increase tear secretion. Calorie restriction (CR) activates longevity gene sirtuins. We also have shown that agents activating sirtuins, such as resveratrol or nicotinamide mononucleotide (NMN) have retinal protective effects. Particularly, NMN is promising since we have confirmed its therapeutic effect against retinitis pigmentosa. Ketone bodies are considered another mechanistic target of CR. We developed eye drops containing ketone bodies, and confirmed a therapeutic effect similar to that of CR. Now we are expanding our investigations to include new therapies for dry eye and neuroprotection for the retina and the optic nerve. Other pathways such as endoplasmic reticulum (ER) stress, inhibition of hypoxia-inducible factor (HIF), and inhibition of the insulin-like growth factor (IGF) are also considered to be targets for the anti-aging approach. Taken together, the new strategy “anti-aging” is one approach in dealing with ocular diseases. The anti-aging approach is promising as the next generation of preventive medicine focusing on aging for the current era with increased health care expenditures


Case Reports


1999 Oct;77(5):564-7.

 doi: 10.1034/j.1600-0420.1999.770517.x.

Histological Findings in the Eyelids of AIDS Patients


Free article


Purpose: The eyelids of 15 AIDS patients (17 specimens) were examined histologically at postmortem.
Methods: Formalin-fixed, paraffin-embedded and haematoxylin-eosin stained sections were examined by conventional light microscopy. The presence of calcific deposits was confirmed by special stains and elemental analysis (X-ray energy dispersive spectroscopy).
Results: 6 cases had abnormal microscopical findings. In two cases deposits of calcium oxalates were observed in the wall of dermal blood vessels and in epithelial cells of sweat and sebaceous glands, respectively. Precipitates of calcium phosphate were observed in the superficial substantia propria of the palpebral conjunctiva in an additional patient. Other histological findings in the remaining three patients included flat warts, an unusual elastotic degeneration of the forniceal palpebral conjunctiva and more common lesions (chalazion, Demodex folliculorum infestation of the eyelashes, trichilemmal cyst).
Conclusion: The presence of microscopical lesions in nearly half of this small series demonstrates that the eyelids may be affected subclinically in AIDS patients.
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