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My son (1.5yo) was just diagnosed with a very, very rare genetic disorder (Primary Hyperoxaluria Type III). The specialist who actually described this disease hypothesises that the genetic mutation causes the pathway for the proper breakdown of animal protein to be blocked. Instead, it takes another pathway which causes the excess production of oxalates and has therefore, recommended a vegan diet for my son (milk and butter ok). I am a bit stumped on what to feed him.

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I read a little about it just now as I've never heard of it. Something something calcium something in kidney. . . I dunno. Veganism never cured anything that I know of. Other than getting people off SAD which anything is an upgrade from. Hopefully someone out there can help though. The best I can do is suggest another physician for a second approval. Especially one who generally promotes healthy eating (paleo, not vegan) and see what they have to say. – Derek Jul 28 at 10:15
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If "animal protein" is not being absorbed well, plant protein definitely won't be getting absorbed any better. I see possible protein deficiency in your child's future. – BoneBrothFast Jul 28 at 15:12
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Sounds like your doctor is lost in the 60's and early 70's with that kind of nutritional recommendation. There is absolutely no benefit for your son to go on a vegan diet rather than a paleo diet. – JoshKrouse Jul 28 at 17:16
Some good low oxalates resources: lowoxalate.info; Yahoo Group to join: health.groups.yahoo.com/group/Trying_Low_Oxalates – Want2BHealthyGirl Jul 28 at 22:26
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Hello Gayle, I am sorry for the rather unhelpful reactionary responses to your question here, this tends to happen whenever a vegan diet is mentioned. It sounds like quite a rare issue that your son has. I am interested in the problem however I do not have time right now to look for a good answer but would be interested if you could post a comment with the name of your specialist who has come up with this hypothesis and give any more details that you have about the disease. – Matt Jul 28 at 22:48
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Not sure I understand how a vegan diet minimizes oxalates... which is the problem with hyperoxaluria. Oxalates are absent in animal products, and present in many plant foods. I'm guessing it stresses the kidneys so they're just trying to minimize urea production, which seems like treating the symptom more than the underlying disorder.

Get additional doctors' opinion, particularly one who's actually worked with this disorder.

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A vegan diet actually has the potential to increase oxalates, depending on what you eat. – BoneBrothFast Jul 28 at 15:12
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I agree. When I ate a vegan diet the oxalate content of my food was much higher than it is now. The issue might be that he can't eat too much animal protein? If that's the case, I'm guessing he could probably do a low-protein diet that's not vegan. At any rate, I agree with Matt: Get him a second opinion. – blueballoon Jul 28 at 22:35
he doesn't have issue with oxalates from plant food. – Sue Jul 30 at 8:38
@Sue, what's the source of problematic oxalates then? – Matt Jul 30 at 11:37
I don't understand it fully myself. The problem is the 4th step in hydroxyproline pathway which would be an issue with animal protein consumption. I find it interesting. – Sue Jul 30 at 23:47
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I finally had time to look this up. I'm interested in kidney problems, and apologize if my previous comment was unhelpful to you. Anyhow! Kidney stones sort of run in my family, and I just asked my closest relative which type she deals with (answer: oxalates). So, here's what I found:

Obviously you've learned all this by now, but for others who are looking at this thread, here's some info on the condition: http://www.ohf.org/about_disease.html

This is some information I found about a low-oxalate diet. I'm not sure if it'll help you totally, but it might be a good place to start: http://www.upmc.com/patients-visitors/education/nutrition/Pages/low-oxalate-diet.aspx

As an overview of the above, it looks like the following generally-kid-friendly foods are low-oxalate:

  • apple juice and cider
  • butter* (not sure how you feel about dairy)
  • avocados
  • bananas
  • melons
  • cherries
  • mangoes
  • white rice
  • cucumbers
  • cauliflower
  • meats except for sardines**

**You mentioned that your son has problems breaking down animal proteins, so I only mention that because it's on the low-oxalate-foods list. I'm not a doctor, so please don't take my word for anything. If he can't digest those proteins, by no means should you just give them to him because they're part of an ideal diet for MOST people. (Your son is not most people.)

At any rate, it looks like a good number of fruits (except a lot of berries) might be okay? I'm a little confused by looking at the condition information whether animal fats might be a problem in addition to proteins, or whether certain starches might be good or bad. If it turns out your son can eat some animal products in small amounts you'll probably have to be pretty choosy as to which ones he eats.

Additionally, dark leafy greens probably aren't the best as they're pretty high in oxalates.

I do think, though, as per my earlier comment, that you may wish to get a second opinion if only to make YOU feel better about making decisions for your son. As a parent, I do not envy your position. Hang in there! You're an awesome parent for trying to figure all this out for your child.

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thank you. it's hard not to be overly concerned about your child's health...especially when he's still practically a baby... – Gayle Jul 30 at 2:07
Fat seems to be an issue for type II, not type I. Not sure about type III. Most have I or II. – Sue Jul 30 at 2:10
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Protein may be issue for type III sciencedirect.com/science/article/pii/… – Sue Jul 30 at 2:20
I'm not a nephrologist, so I don't understand which conditions warrant low carb/protein/fat, but if they're recommending low protein and fat is OK I imagine that maybe rendered animal fats (ghee, lard) that don't have protein might work? If those aren't, and vegetable fats are OK, you could probably do avocado, coconut, and olive oil. I use those liberally with my kids. (Actually, my son preferred only to eat homemade guac and very little else when he started eating food.) Gayle- Would you please let us know what you end up doing and what you find out from the doc or another doc? – blueballoon Jul 30 at 11:17
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Get a second and third opinion. Do what's best for your family. If you find that all your additional consults advise a vegan diet then do it. It's so different now and you know it's really all first world problems all this diet debate stuff. My mother had a rare disease so be prepared for a lot of ignorance. There's an Internet group for everything. Go find allies :)

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yeah, it's just really hard for me to wrap my head around this. vegan just seems like the opposite of paleo... – Gayle Jul 30 at 2:05
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but if certain pathways involved in animal protein conversion doesn't work you have to avoid it. So paleo is not healthy for your son. – Sue Jul 30 at 8:42
@sue, yes - that seems to be the case. – Gayle Jul 31 at 1:51
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Primary hyperoxaluria is more than just avoiding oxalates, though that's important too. Yaacov Firshberg, the specialist your doctor is consulting with, believes (and his evidence is convincing) that people with PH3 have an issue with hydroxyproline due to a mutation of the gene involved with the pathway by which hydroxyproline can be converted into oxalate.

Since animal protein is the really the main significant dietary source of hydroxyproline it makes sense that he would advocate a vegan diet. But I still think it's a bad idea.

I don't have an issue with a diet low in animal protein in this case, but eliminating animal products completely comes with risks of deficiencies. My recommendation is to keep animal protein low except for the occasional nutrient dense animal food, for example oysters, pastured egg yolk, and grass fed beef liver. Beyond that, look for food with low oxalate content, there are lots.

And hey, pastured animal fats are low oxalate and hydroxyproline too!

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thank you so much for that! i was just told by the nutritionist assigned to my son that we're allowed to occasionally give him egg yolk. i will query the oysters and beef liver. i agree with a vegan diet being a bad idea... – Gayle Jul 30 at 6:46
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also was informed that oxalates from food will not affect his oxalate levels as much as animal protein. – Gayle Jul 30 at 6:53
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You're welcome, hope I could help since I'm sure this is an issue of significant importance to you. – Mscott Jul 30 at 7:15
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Also, I'm no expert but I agree that dietary oxalates are likely of lesser concern than HP, but I would still seek to minimize them. – Mscott Jul 30 at 7:16
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How bizarre. Vegan & vegetarian diets are often very high in oxalic acid due to the amount of soy, legumes, grains and leafy greens they eat. Are you sure he wasn't talking about uric acid?

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definitely oxalate – Gayle Jul 30 at 2:02
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Either, you've been misinformed or you are toying with us. If not, you should go to a different MD or a Nutritionist.

Who diagnosed him?

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Yeh, you have no control unfortunately. Are you in Perth? – Sue Jul 30 at 2:29
Ask them for papers etc, anything to understand it more fully and how protein plays into it. – Sue Jul 30 at 2:30
In type 1 and 2 can't do the required conversions of oxalates from plant foods but in type 3 this is okay, just can't do the conversions from animal protein foods? – Sue Jul 30 at 2:35
How do you know if he has been diagnosed correctly? – Alvaro Jul 30 at 6:32
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Don't be scared just educate yourself on the best vegan protein sources to give him. People can be health on vegan/vegetarian if done correctly. – Sue Jul 30 at 8:39
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A friend of mine's kid had a lot of digestive issues for his first 5 years, he was at times diagnosed with various food allergies (dairy, protein, wheat, sugar, etc), later with "leaky gut", and some other things mixed in. She went through at least a half dozen doctors as the kid would get better and then worse again with slightly different symptoms, and it was a long and agonizing road.

After many years, she finally struck on a diagnosis of a fungus overgrowth in his gut, which was found by a homeopathic doctor, and was treated by a high concentration of garlic in his foods for about 6 weeks. It was uncomfortable at first (the theory is that the fungus fights back before dying off) but he was eventually completely cured and has been fine ever since.

I say this not to suggest that your kid has the exact same condition, but just that digestive disorders are tricky to diagnose and doctors don't always get it right, and tend to have strong biases. For example doctors with a genetic background tend to find genetic disorders, homeopathic doctors tend to find problems with diet and well-being, most doctors try to get you out of their office with a prescription. I would get a 2nd or 3rd opinion for your kid.

I am not a doctor but am very skeptical of a vegan diet as a diagnosis, since I think that a vegan diet just simply doesn't nourish a human sufficiently, and have seen many people improve their health significantly by switching FROM a vegan diet. Going vegan might get your kid through a rough patch but I don't think it is a viable long term alternative.

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