Do you like juice? This is very much a reminder that a good thing can be unhealthy or very rare and even harmful.
A liver specialist is sounding the alarm about fad diets being promoted online and calling for a “detox juice” with lots of fruit and raw vegetables in a blender.
Dr. Abby Phillips says she has seen two patients who appeared to have kidney damage after consuming ingredients such as gooseberries, beets, spinach, green leafy vegetables and citrus fruits in a daily homemade juice.
“Please don’t. OXALATE CAN CAUSE KIDNEY DAMAGE AND THE KIDNEYS TAKE A LONG TIME TO RECOVER,” Phillips tweeted last month.
Phillips says an occasional serving of fruit or vegetable juice isn’t harmful, but wants to caution people — both healthy and those with chronic liver disease, kidney disease or diabetes — about mixing vegetables and fruits “unreasonably.”
“For example, juicing oranges and avocados with beets and spinach can cause high levels of oxalate in the end product, which can damage the kidneys,” says Phillips, MD, a hepatology and liver transplant specialist at Rajagiri Hospital in Kerala, India. TODAY.com
“The only toxins that actually work on humans are their own livers and kidneys. As I always say ‘we don’t clean the liver, the liver cleans us’. There is no need to tox as the only aspect of withdrawal is the person’s bank savings.
Renal specialist Dr. Ray Bignall says oxalate kidney damage isn’t something that affects the average juicer at breakfast, but he agrees it’s important not to overdo it.
“The bottom line is, I think like your mother told you, everything in moderation,” Bignall, MD, a pediatric nephrologist at Nationwide Children’s Hospital in Columbus, Ohio, told TODAY.com.
“The author of the tweet was right to raise concerns about fad diets and unhealthy eating trends. Of course, anyone who wants to participate in any special diet or nutrition program should always consult with a licensed nutritionist and their physician to do so safely.
What are oxalates?
Oxalate is a compound found in many foods, especially some leafy vegetables, Bignall explains.
According to the National Institutes of Health, oxalate-rich foods include:
Fruits: Rhubarb, currants, canned fruit salad, strawberries and Concord grapes
Vegetables: beets, leek, summer squash, sweet potato, spinach and tomato soup
Beverages: Tea and instant coffee
Other foods: grits, tofu, nuts and chocolate
How do oxalates affect the kidneys?
Producing or consuming too much oxalate can eventually lead to kidney damage, researchers warn in the World Journal of Nephrology and Urology.
This type of damage may be associated with an inherited metabolic disorder called oxalate nephropathy or an intestinal disorder.
But if a person eats too many oxalate-rich foods like leafy greens, rhubarb, asparagus, nuts and soy products, “especially in juicing diets,” studies have found.
Dr. Joseph Vasalotti, chief medical officer of the National Kidney Foundation, says this is unusual.
“I worry about scaring people about a rare or unusual problem with beverages that are generally healthy for most people if consumed in moderation,” Vassalotti told TODAY.com in a statement.
Bignall agrees that this type of injury is extremely rare. People at risk may include oxalate-rich foods as part of a “juice fast” and consume large amounts of juice.
Too much juice
Consider the case of a 68-year-old man who developed severe acute oxalate nephropathy six months after starting a daily diet of oxalate-rich fruit and vegetable juices.
He mixed one-third of a pound of raw baby spinach leaves with swiss chard, then added broccoli, cauliflower, green beans, asparagus, cabbage, beets, cilantro, parsnip, mushrooms, onions, and blueberries or strawberries. He added 4 pints of water to the mixture and drank one pint every day.
A breakfast consisting of oatmeal and vegetables, and a lunch and dinner of pureed yams, spinach, Swiss chard, tofu, and garbanzo beans, reported that a person’s daily oxalate intake was about 10 times greater than a typical diet. Nephrology.
Another case report involved an 81-year-old man who developed diet-related oxalate nephropathy following a diet rich in almonds, which also included drinking more than 4 cups of almond milk daily. Studies have shown that the beverage has the highest concentration of oxalate of any plant-based dairy alternative.
It’s important not to overdo it when it comes to one’s diet, says Bignall. That includes people with healthy kidneys and those with mild kidney impairment from high blood pressure or diabetes who “go to extremes” and consume unhealthy levels of oxalate-rich foods, he said.
“Do I think people are putting themselves at risk by consuming one or two juiced vegetable or fruit drinks a day? No, the average person can have a reasonable couple of juiced drinks a day,” says Bignall.
We physicians want to encourage our patients to eat healthy foods. But like anything, too much of a good thing can be a bad thing,” says Bignall.