INTERESTING: Vulvodynia, Oxalates, and Diet

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Vulvodynia, Oxalates, and Diet

august 26, 2008 af usredaktionen

Vulvodynia (also called vulvar vestibulitis or vulvular pain syndrome) is a condition that involves irritation and pain in the vulva and surrounding tissues. There is little controversy in the scientific community as to whether this disease exists, although its prevalence is unkown, and many doctors still may not recognize and diagnose it. And modern medicine is still uncertain as to the cause of vulvodynia. One theory is that vulvodynia can be caused by oxalates.

Oxalate is an organic compound that is found in many foods, and is also a by-product of some metabolic processes in the body. Oxalates (in the blood in the form of free oxalic acid) are ordinarily filtered by the kidneys into the urine, and eliminated from the body. If the kidneys do not filter fast enough, oxalates can form crystals that develop into painful kidney stones. If the concentration of oxalates in the urine is too high, microscopic crystals can form in the bladder. Some cases of vulvodynia has been linked to microscopic oxalate crystals irritate the nerves in a the urethra.

In early 2006, there were two articles on the PubMed database that involved research into oxalates and vulvodynia. The first article from 1991 (PMID:1816400:) was a case report of a woman that had suffered from vulvodynia for 4 years, and the condition had become debilitating. A series of tests showed that the alkalinity and oxalate level of her urine often rose to abnormal levels, and her discomfort was linked to these surges in oxalates. The woman was put on a program to control oxalates that included a calcium citrate supplement. The woman improved significantly by a 3 month follow up, and was symptom free after a year on calcium citrate. When the woman stopped taking calcium citrate, her symptoms would return; when she restarted the supplement, her vulvodynia went into remission. So in one case, a strong relationship between oxalates and vulvular pain was demonstrated.

A second study was conducted in 1997 that included 130 women with vulvular pain syndrome (PMID:9322615). Lab tests showed that just under half of the women (59 patients) had elevated oxalate levels. These 59 were put on a program that included a low oxalate diet and calcium citrate. The results of this study were less dramatic than in the first case study: 24% (14 patients) demonstrated an ‘objective improvement’ and 10% (6 patients) improved to the point of being able to have normal sexual intercourse. The researchers concluded that oxalates might aggravate vulvodynia, but was not the cause for most women in the study.

From the limited research (and from anecdotal information on the web), it can be said that a program to reduce oxalates in the diet along with a supplement of calcium citrate might provide a measure of relief to some women with vulvodynia. It does not appear to be a ‘cure’ in any sense, but it may reduce symptoms, and if combined with other appropriate treatments, could make life more bearable. And that is a good thing.

Calcium citrate works by increasing the solubility of oxalates in the urine - the citrate portion of the supplement prevents the crystals from forming, and lets the oxalate be flushed out of the body. Another supplement that does the same thing is magnesium citrate; some research has suggested that magnesium citrate may be even more effective than calcium citrate. Other forms of calcium or magnesium bound to ‘Krebs-Cycle intermediates’ also appear to be effective. These include calcium or magnesium bound to succinate, malate, or fumarate.

The most common forms of calcium found in supplements (calcium carbonate and magnesium oxide) do NOT appear to reduce oxalates as it is not just the calcium or magnesium that helps - the citrate (or malate) is also needed. Cal-trate is one widely marketed brand of calcium citrate, and others are mentioned below.

Calcium citrate is generally well tolerated, although those with a pre-existing medical condition (particularly kidney or heart disease) should consult their doctor before adding a calcium or magnesium supplement. These supplements are beneficial for many people, but not all.

Calcium tends to slow the bowels (perhaps even causing constipation) while magnesium can work in the opposite direction. A mix of calcium and magnesium is less likely to have these side effects. The body needs both magnesium and calcium, and taking too large a supplement of either can throw off electrolyte balance over time.