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ABSTRACT oxalic acid: (COO)2H2 (4). In food, oxalic acid is typically found
Background: High oxalate intake resulting from consuming sup- in its salt form, primarily as either sodium or potassium oxalate,
plemental doses of cinnamon and turmeric may increase risk of which are water soluble, or calcium oxalate, which is insoluble.
hyperoxaluria, a significant risk factor for urolithiasis. The propensity of a specific food to raise urinary oxalate is
Objective: This study assessed urinary oxalate excretion from sup- dependent both on oxalate content and efficiency of absorption
plemental doses of cinnamon and turmeric as well as changes in because it is well established that little oxalate catabolism occurs
fasting plasma glucose, cholesterol, and triacylglycerol concentra- after absorption and 쏜90% of absorbed oxalate can be recovered
tions. in the urine within 24 to 36 h (7).
Design: Eleven healthy subjects, aged 21–38 y, participated in an Oxalate absorption in the small intestine occurs via active
8-wk, randomly assigned, crossover study that involved the inges- transport, and there is passive absorption along the gastrointes-
tion of supplemental doses of cinnamon and turmeric for 4-wk pe-
tinal tract (8). Oxalate solubility within the small intestine ap-
riods that provided 55 mg oxalate/d. Oxalate load tests, which en-
pears to be a critical factor as evidenced by the propensity of
tailed the ingestion of a 63-mg dose of oxalate from the test spices,
concomitant calcium ingestion to reduce oxalate absorption (5,
were performed after each 4-wk experimental period and at the study
9), presumably by chelating with oxalic acid in the small intes-
onset with water only (control treatment). Fasting plasma glucose
tine. An unanswered question is whether the solubility of oxalate
and lipid concentrations were also assessed at these time points.
Results: Compared with the cinnamon and control treatments, tur- in a specific food source is an important predictor of efficiency of
meric ingestion led to a significantly higher urinary oxalate excretion oxalate absorption. The assertion that the amount of soluble
during the oxalate load tests. There were no significant changes in oxalate in food is a major determinant of oxalate absorption is
fasting plasma glucose or lipids in conjunction with the 4-wk periods supported by some (10, 11) but not all studies (12).
of either cinnamon or turmeric supplementation. Spices such as cinnamon and turmeric are currently being
Conclusions: The percentage of oxalate that was water soluble consumed in supplemental doses because of their purported
differed markedly between cinnamon (6%) and turmeric (91%), health benefits (13, 14), which include improvements in glyce-
which appeared to be the primary cause of the greater urinary oxalate mic (15, 16) and lipid profiles (15, 17, 18). However, no studies
excretion/oxalate absorption from turmeric. The consumption of to date have reported the oxalate content and oxalate solubility of
supplemental doses of turmeric, but not cinnamon, can significantly these spices or assessed the efficiency of oxalate absorption.
increase urinary oxalate levels, thereby increasing risk of kidney Because previous unpublished work in our laboratory suggested
stone formation in susceptible individuals. Am J Clin Nutr that cinnamon and turmeric are high-oxalate spices, their sup-
2008;87:1262–7. plementation could have a significant influence on total oxalate
absorption and urinary excretion, an important consideration for
individuals predisposed to the formation of calcium oxalate-
INTRODUCTION containing kidney stones. Thus, the primary objectives of this
About 75% of all kidney stones are composed primarily of study were to quantify the total and soluble oxalate content of
calcium oxalate (1), and hyperoxaluria is a primary risk factor for cinnamon and turmeric and to assess and compare the change in
this disorder (2). Urinary oxalate, derived from a combination of urinary oxalate excretion from these 2 spices. A secondary ob-
exogenous and endogenously synthesized oxalate, is a primary jective was to assess fasting plasma glucose, cholesterol, and
determinant of the level of calcium oxalate saturation (3). Al- triacylglycerol responses to 4-wk periods of cinnamon and tur-
though it had been accepted that dietary oxalate contributes no meric supplementation in a healthy, nondiabetic population.
more than 10% to 20% of the oxalate excreted in the urine under
1
normal conditions (1, 4), recent work (5, 6) suggests that even in From the Department of Family and Consumer Sciences (Human Nutri-
the absence of gastrointestinal disorders, intestinal absorption of tion), University of Wyoming, Laramie, WY.
2
Supported by funding from the University of Wyoming.
dietary oxalate can make a more significant contribution to uri- 3
Reprints not available. Address correspondence to M Liebman, Depart-
nary oxalate. Thus, high oxalate intake may increase risk of
ment 3354, 1000 E. University Avenue, Laramie, WY 82071. E-mail:
hyperoxaluria, a significant risk factor for urolithiasis. liebman@uwyo.edu.
Oxalate is a common component in food, including nuts, Received August 21, 2007.
fruits, vegetables, grains, and legumes, and is a salt or ester of Accepted for publication December 13, 2007.
1262 Am J Clin Nutr 2008;87:1262–7. Printed in USA. © 2008 American Society for Nutrition
endogenous oxalate excretion was assumed to be constant headache in association with taking cinnamon on the test day.
throughout the day. The 6- and 22-h endogenous oxalate was Another subject reported an occasional burning stomach during
computed by multiplying the B-2 urinary oxalate by 3 and 11 for the 4 wk of cinnamon consumption. There were no other reported
6 and 22 h, respectively. The original intent was to use the B-2 symptoms with either cinnamon or turmeric consumption.
from each treatment to compute net oxalate over 6- and 22-h
postoxalate time periods. However, the mean CV across all sub- Total and soluble oxalate content of cinnamon and
jects for B-2 urinary oxalate on the 3 test days was high (17.6%). turmeric
Thus, a more accurate estimate of 2-h endogenous oxalate could
be obtained through the use of the average B-2 across the 3 The total oxalate content of cinnamon and turmeric, analyzed
treatments for each subject. The average B-2 urinary oxalate was in duplicate on 4 occasions, was 1789 앐 54 and 1969 앐 56
used to approximate each subject’s 6- and 22-h endogenous mg/100 g, respectively. The percentage of oxalate that was water
oxalate excretion, which in turn was used to compute net oxalate soluble differed markedly between cinnamon (107 앐 8 mg/100
excretion (ie, net oxalate ҃ total oxalate – endogenous oxalate). g, 6% of total) and turmeric (1788 앐 1 mg/100 g, 91% of total).
Finally, net oxalate was used to approximate oxalate absorption
(ie, percentage absorbed ҃ net oxalate/63 mg, with 63 mg rep- Oxalate and calcium content of the provided breakfast
resenting the amount of oxalate provided by cinnamon and tur- and snack
meric on the test days). An attempt was made to provide similar breakfasts and snacks
Statistical analysis for each subject for the 3 treatments to minimize the potentially
confounding effect of differing nutrient intakes, especially ox-
The initial statistical analysis made use of a crossover exper- alate and calcium. The breakfast was designed to be low in both
imental design to test the hypothesis that the cinnamon/turmeric oxalate and calcium. Computed oxalate intakes (x 앐 SD) for this
treatment order did not influence the results. When no treatment meal were 8.3 앐 4.1, 6.4 앐 3.8, and 6.8 앐 5.0 mg for the control,
order effect was detected, subsequent statistical analyses tested cinnamon, and turmeric treatments, respectively; the corre-
for treatment effects without regard to treatment order. Treat- sponding calcium intakes from breakfast for the same order of
ment differences in oxalate load urinary volume, oxalate, creat- treatments were 77 앐 25, 67 앐 21, and 60 앐 29 mg. Mean oxalate
inine, and ratio of oxalate to creatinine were tested with use of a intakes from the snack ranged from 21.2 to 22.8 mg for the 3
repeated-measures analysis of variance in which both treatment treatments. Because the snack was provided 쏜4 h after the ox-
and time (with time representing the different time periods of alate loads were ingested, calcium consumed at this time would
urine collection during the oxalate load tests) were entered into not be expected to interfere with oxalate absorption from the
the model. When a significant treatment effect, but no significant oxalate loads. Thus, these calcium intakes were not strictly con-
treatment-by-time interaction, was observed, the interpretation trolled with mean intakes for the 3 treatments ranging from 380
was that the treatment effect was essentially consistent over the to 420 mg.
different time periods of urine collection during the oxalate load
tests. In this case, differences were not presented across treat-
Oxalate absorption from cinnamon and turmeric
ments at specific time points. In instances for which both signif-
icant treatment and treatment-by-time interactions were ob- Baseline as well as postoxalate load urine volumes and oxalate
served, treatment differences at specific time points were and creatinine levels are presented in Table 1. There were no
determined with use of the Tukey post hoc test. Treatment dif- significant treatment differences for either urine volumes or cre-
ferences in plasma glucose, cholesterol, and triacylglycerols atinine levels. The statistical analysis indicated a significant
were tested with use of a repeated-measures analysis of variance. main effect of treatment but no significant treatment-by-time
Statistical calculations were based on the general linear model interaction for postload urinary oxalate levels. The Tukey sepa-
procedure of SAS (version 8.1, SAS Institute Inc, Cary, NC). ration test of treatment means, averaged over the 5 separate time
Values of P 쏝 0.05 were considered to designate statistical sig- points, indicated a significantly higher mean urinary oxalate for
nificance. Data are reported as means 앐 SD. the turmeric compared with the control treatment, whereas the
control and cinnamon treatments were not significantly different.
The total 6- and 22-h urinary oxalate parameters represent the
RESULTS total oxalate excretion accumulated after B-2 for 6 and 22 h. The
Eleven subjects (7 women, 4 men) completed the study. The significantly higher urinary oxalate for turmeric, compared with
mean participant age was 27 앐 6 y (range: 21–38 y) and the mean both the control and cinnamon treatments, for the total 6-h pa-
BMI was 24.7 앐 2.5 kg/m2 (range: 21.0 –28.2 kg/m2). Overall rameter appeared to largely account for the similar finding for the
compliance with taking the cinnamon and turmeric supplements total 22 h parameter. There were no significant differences be-
was judged to be excellent on the basis of the return of empty vials tween the cinnamon and control treatments for either total 6-h or
that had contained the daily allotment of capsules. Two subjects total 22-h urinary oxalate levels.
missed taking 9 capsules during the 8-wk supplementation pe- Baseline as well as postoxalate load urine ratios of oxalate to
riod, and 1 subject missed 5 complete days during the turmeric creatinine are presented in Table 2. The statistical analysis in-
supplementation period because of illness. The return of empty dicated a significant treatment effect as well as a significant
vials suggested that the remaining subjects consumed all the treatment-by-time interaction. There were no significant treat-
provided supplements. ment differences for B-2 and S-22. The ratio of oxalate to creat-
Four subjects reported experiencing eructation in association inine for the turmeric treatment was significantly higher than the
with taking cinnamon either on the oxalate load test day or during corresponding ratios for the control and cinnamon treatments for
the 4 wk of daily ingestion. One subject reported experiencing a S-2, S-4, and S-6.
Fasting plasma glucose, total cholesterol, and triacylglycerols Net 6 h (mg) 1.7 앐 2.0 a
5.2 앐 2.6b
for the control, cinnamon, and turmeric treatments are summa- 6 h absorption (%) 2.6 앐 3.2a 8.2 앐 4.2b
rized in Table 4. At the initial (control) time point, all subjects Net 22 h (mg) 1.9 앐 3.3a 4.8 앐 4.6b
had normal fasting blood glucose (쏝100 mg/dL) and total cho- 22 h absorption (%) 3.0 앐 5.3a 7.7 앐 7.4b
lesterol (쏝200 mg/dL) concentrations. Four subjects had ele- 1
x 앐 SD; n ҃ 11. Means within a row with different superscript letters are
vated fasting triacylglycerol concentrations (쏜150 mg/dL). significantly different, P 쏝 0.05 (repeated-measures analysis of variance).