Latest / NHA Today Podcast / Your Kidneys Work Hard. Are You Protecting Them? with Dr. Stephan Esser
Transcript
- Stephan Esser MD: Hi, and welcome to another edition of the NHA Today podcast. You know, today I just wanted to sit down and have a little conversation with you about kidney health. Yeah, that's right. It's on my brain. I wanted to share it with you. You know, we don't give enough credit to our kidneys for the amazing amount of work they do for us to keep us healthy. And today I wanted to go through a little bit of the anatomy of the kidneys, the physiology, some lab tests for you to think about and how to really keep your kidneys healthy. What's the optimal diet for all of us when it comes to our kidney health? So let's jump. Right in. We're going to visit the anatomy and physiology classroom. We're going to discuss some common kidney conditions. We're talking about the intersection between lifestyle and kidney health and develop a game plan to keep your kidneys healthy for a lifetime. You know, the kidneys are quite complex. You can see some images here where we see these blood vessels, the arteries and the veins coming off the aorta there and the vena cava, feeding right that kidney. We can see the different components of the kidney: this outer cortical layle, medulla, the papilla. The pyramids, all of these different aspects. And at the heart of the function of the kidney are tiny little tubules. These tubules are the nephrons, they're called, and they're got the glomerulus at the top of them. And this little very intricate and very detailed component, there are millions of them in each kidney, and they work together to filter your blood. So each of your kidneys is about five inches by two inches. They filter 50 gallons of blood a day. That's a lot of blood. And every time that your heart beats, when it contracts, 30% of that single contraction goes right out into your kidneys. That's how important they are. In fact, the metabolic rate, the rate at which they function and work, is as high as your heart. Wow, to think about that. Consider how incredibly active these kidneys are, right? Because the heart's just going pump, pump, pump, pump all day long, and you're running and exercising. And yet the kidneys have the same metabolic rate. They're using the same amount of energy. From your body. And as we mentioned, they're king or queen when it comes to blood flow because 30% of every single squeeze goes right to the kidneys. Now, what do they do? They filter your blood, they remove waste products with names like uric acid, creatine, various amino acids, excess fluid and salt. They produce urine, right? Anywhere from 800 to 2000 milliliters a day. They help control your blood volume and blood pressure, and they control your pH levels. We take for granted our ability to think clearly, to walk, to move, et cetera, until we lose it. And it turns out that the pH levels of our body are exquisitely controlled, in particular by the kidneys. And if we go too acidotic, right, low, or too alkalotic, high, outside that tiny little window of 7.35 to 7.45, bad things can happen. Enzymatic processes no longer work the way they should. The kidneys are also important because they're involved with the production of vitamin D. Which we know is so crucial for immune function, for bone health. We also know that they're involved with erythropoietin production. This molecule helps with oxygenation of our tissues and function and performance. Now, the kidneys are affected by a host of different molecules, different proteins, different peptides, cortisol, perithyr hormone, calciton, and angiotensin, right? Brain naturiatic peptide, so many. And so different aspects of our body are producing these. Whether it be from the pituitary gland, whether it be from the thyroid, whether it be from the adrenal glands, right? Different tissues produce these molecules that then go to the kidney and influence what occurs there. Now, this is the business side of the kidney. This is that little convoluted tubule I spoke of with the glomerulus at the beginning. So blood flows in and blood flows out. When it flows in, there's a whole aspect of diffusion that occurs across these capsule, across these tubules. In fact, In medical school, we had to memorize what occurs at each one, the proximal, the distal, the loop of Henley, the collecting duct, what goes on here or there and everywhere. And it turns out that different molecules are absorbed or excreted at different areas. And so the whole purpose of this convoluted tubule, of course, is to remove the waste products to retain just the right amount of water and salts, and then to produce urine. So that urine is collected in the kidneys. It goes out via the ureter. The ureter is the tube that dumps into the bladder. Then a bladder dumps the urine into the urethra, and that goes out, either through the vaginal opening or through the penis, and then. And so this is what we see: this incredibly detailed process that occurs at each level. Now, at each of these levels also, different medications, different toxins, different herbs can all influence renal function. When you look at your kidneys, you want to know how they're functioning. As I mentioned, they're crucial as what? removal of waste. They're a filtration system. And so some basic numbers you should be aware of include your GFR, which is the rate of filtration through the kidneys. So the amount of volume, the amount of milliliters, right, that goes through the kidneys per minute. Your B U N, this blood urea nitrogen test, is the amount of nitrogen in your bloodstream as a byproduct of protein breakdown in the liver. So, how much, right, is there? And then your creatinine. It's a measurement of a waste product from metabolism, digestion of proteins, as well as a breakdown from just muscle activation and activity. So you want your GFR to be nice and high, and you want your BU1 and creatinine to be relatively low, but in a sweet spot, not too low and not too high. Because this is all about balance. That's what the kidneys are all about. When things become imbalanced, we enter into a state of pathology. And there are a whole host of things that can happen to your kidneys. Everything from the basic things like kidney stones and chronic kidney disease, all the way to the abnormal, sort of genetic inherited abnormalities of the kidneys. Now, we're going to talk today about the very common disease processes that occur in the kidney. And we'll save for another day the more unique sort of zebras, if you will. Let's start with kidney stones. There are four major types of kidney stones: calcium oxalate, calcium phosphate, struvite, and cysteine. The struvite and the cysteine are both involved with some form of infection. Calcium oxalate and calcium phosphate are more related to a combination of genetics, hydration, the food we eat, and the substances that we're exposed to. You see, the kidneys, as I mentioned, are made up of millions of these little tiny nephrons, and they're trying to filter out your blood. But if we get too much of certain salt solutes, right, left in this area, now it's gonna build up into tiny little particles. And those little particles will rapidly progress into maybe like a little pearl. And that little pearl then can begin to irritate or get stuck as fluid is trying to flow into those nephrons. It's blocking up those areas. This creates inflammation, which attracts white blood cells and other immune cells. And then this results in some scarring and fibrosis. And now those very delicate, what were once kind of like tissue paper nephrons now become kind of scarred and dysfunctional. And now as a result, we're not able to get good blood flow in there. And thus we're not able to filter the blood effectively. And this becomes a problem. And if those little stones pop into, let's say, the ureter, now they become extremely painful. And this is where the person who develops mid-back pain, right? They have these spasms, this extreme pain. As you may have heard, right, many people describe kidney stones being about the same as labor, right? And so this extreme discomfort that people feel in the back. Now, what form of nutrition is best for kidney stones? Turns out that the data is quite robust, that the more plants that you eat and the less animal-based food you eat, the lower your risk of kidney stones. That's right, total meat consumption, processed meat consumption are all directly linked. With increased rate of kidney stones versus the more fruits, vegetables, and fiber-rich foods you eat is directly related to a reduced risk of incident kidney stones. So if you're eating a strong plant program, wonderful. You are doing good things for your kidneys. Now, people always bring up this good question: Do oxalate-rich foods, for example, like spinach, increase the rates of kidney stones? Well, Turns out that they do if you're eating an otherwise unhealthy diet. And they may if you have a very strong genetic predisposition, and they may, if you're on certain medications, right, that alter the nephron and the sort of physiology in that area. But on average, in people who are eating a strong plant program, plant-based diet that's all micronutrient-dense whole foods, consuming oxalate-rich foods does very little to significantly increase your risk. So if you have History of kidney stones yourself or a strong family history, you may want to consider a lower oxalate consumption. But otherwise, keep eating that spinach. The benefits far outweigh any risks. In fact, what we see, and you can see it here, that there is a direct sort of reduction. As you reduce the amount of meat that you consume, you significantly reduce the risk of developing kidney stones. Good news for you and I, so that we have a power to make intentional choices. Likewise, when we eat the animal-based foods, we're getting a large quantity of purines. Those purines are broken down in the bloodstream into uric acid. That uric acid has to be excreted through the kidneys, and the more of it that builds up, of course, begins to alter the chemistry of the kidney and increase the risk of kidney stones. Another common cause of kidney dysfunction is hypertensive nephropathy. What does this big word mean? Means that when your blood pressure goes up, that's the hypertension. That it causes pathology or damage to the kidney, the nephrons, right? So how does this work? Well, when your blood pressure is increased throughout your body, there's more pressure. There's more sort of think about a hose, right? Imagine putting that hose at full force, right? At that setting where it's this tight sort of spray and you put it right on some tissue paper, it's just gonna tear right through. But imagine if you just let a little bit of water dribble out onto the tissue paper. Doesn't tear it in the same way. So when you have elevated blood pressure that is just banging on that kidney day in and day out, what happens is what? It actually damages right the nephrons, leading to, as I said earlier, inflammation and then scarring. So now we have damaged tubules with scar tissue surrounding it, and it just can't do its job. You no longer have the nice flexible membrane. The filtration is reduced, and now our GFR reduces. And the other markers of inflammation and dysfunction increase. On these histologic slides, you can see an otherwise healthy sort of microtubule area versus all this scarring that occurs progressively with elevated blood pressure. This is why it's so crucial that you and I test, don't guess. We get out there and test our blood pressure on a regular basis and don't take for granted that it's going to be in a normal level. Now, another primary cause that occurs frequently is diabetic nephropathy. Use it, let's break it down. Diabetes with that elevated blood sugars and nephropathy, right? The nephrons become pathologic or damaged. And what occurs here is that we have this elevation in blood sugars, what we call hyperglycemia. And this leads to chronic inflammation at the cellular level. This leads to this reduction in oxygen or oxidative damage that occurs. And then it just kind of all builds up to where we get damage at the microvascular level, at the nephron level, with more scar tissue forming. And now we get fibrosis and we no longer able to filter the blood the way that we should. Turns out, in fact, that diabetic nephropathy is one of the leading causes of kidney failure in America today, because type 2 diabetes is so incredibly common, especially with the radical increase in BMI that we've seen over time and the ultra-processed food consumption that throws off right insulin function at the cellular level. So diabetic nephropathy leads to chronic kidney disease, right? And kidney disease is the fastest growing non-communicable disease in the US. You think about this, 35 million Americans have kidney disease, 808,000 are living with kidney failure, and more than 557,000 are on dialysis. That equates to a massive amount of spending. You can see it here, right? That chronic kidney disease costs $87.2 billion. This is tragic because the majority of chronic kidney disease need not exist. And if caught early enough, can be reversed simply through dietary measures. But right now, almost 600,000 people in America every week, right, every several days, are having to go sit in chairs just like this, have their blood pumped out of them, purified by machines, and pumped back into them. That's dialysis. And that's where the extreme expense, along with the other sort of risks that occur, right? The complications related to renal impairment. So we want to do everything we can for ourselves, our families, and the people we love and care about to reduce their risk. Now, chronic kidney disease is broken down into several stages. You can see them here. So a healthy GFR is right anywhere from 100 to 130. We'd like to see that glomerulent filtration rate, right? Remember that's how many milliliters are filtered through the kidneys, you know, in per minute. And so when we look at this, right, Anytime that we start getting impairment, we get to 90 or a little above, that's mild kidney damage. That's stage one. Now we get 60 to 89 on the GFR. This is stage two. Kidneys are still working well, but there's some mild damage. Now we get into stage 3A and 3B. This is where we begin to drop that GFR below 50, and we start getting to this place of mild to moderate or mild to severe damage, or now the kidneys are not working as well. This becomes a real problem because now. Our levels of toxic urea, creatinine, different breakdown products of protein metabolism begin to build up in the bloodstream. And this creates all manner of dysfunction at the cellular level. And so we don't want that, right? We want to have good healthy kidneys. So if you or a loved one has entered into, you've been told you have stage one, stage two, stage three A, chronic kidney disease. And in my experience, the majority of people can radically reverse this. By making radical changes in their nutrition for about four to eight weeks and then reevaluating or retesting. There's so much that's in your control. We've got, right, the things that increase the risk of chronic kidney disease. Let's talk about things out of your control. People over the age of 60, African American versus Hispanic versus Caucasian, a strong family history, abnormal kidney structure that you have some previous injury or were born with a abnormal shape. These are things out of your control. It's good to know them. Just so you can say, okay, I do have increased risk. But what are the things in your control? That's what we really care about. We've got diabetes as the leading thing in your control, right? If you go back and watch my video on type 2 diabetes, you'll see that 90 plus percent of the time, type 2 diabetes need not exist. The majority of us can be radically reversed. Then we've got high blood pressure, obesity, smoking, heart disease with high cholesterol, impairing blood flow. Various medications, diet and hydration, there's so much at your fingertips that you can do to reduce your risk and to reverse some of the chronic kidney disease. Now, when we talk about chronic kidney disease, some people forget that medications actually increase the risk of chronic kidney disease. Medications like nonsteroidal anti-inflammatory drugs, these things like ibuprofen, motor, and a leave, they inhibit the production of prostaglandins. Prostaglandins are molecules that cause some pain experiences in our body, but they're also involved with dilating the arteries that feed your kidneys. So if you're taking a medication that inhibits prostate line information, now you're not going to get as good of blood flow to the kidneys. And that chokes off the kidneys, they become dysfunctional and they begin to develop some chronic kidney disease. Then we've got the PPIs that are medications used to treat gastric reflux, which the majority of people, if they're eating an excellent program at a good time of day, Chewing appropriately, avoiding the things that like caffeine, super spicy food, alcohol, chocolates, these sort of things that dilate the esophageal sphincter and make you more likely to reflex acid into the esophagus. But if you're eating a healthy program, on average, you don't need these. Medications like diuretics, crazy to think, right? That the drugs, their first line treatment for high blood pressure, actually increase your damage of your kidneys. Laxative contrast diantibiotics, the list goes on and on. So you want to look in your medicine cabinet. And if you're taking medication, look up online. Does this increase the risk of chronic kidney disease? If it does, then ask the question: do I really need to be on this medicine? Or are there other options? Right? Like I mentioned, like with diuretics, if you're on a hydrochlorothiazide, just know, right, that go on an excellent plant-based program as advocated by the NHA. Within four to six weeks, eighty plus percent of people can be off their blood pressure medicines with normal numbers. This is good, well-validated studies, over a hundred plus published in the peer-reviewed medical literature, showing that this is possible for you. You don't have to be on chronic medicine for blood pressure the majority of the time. The majority of the people can get off their medicine with normal numbers within four weeks. This is really cool stuff. So much good that you can do for yourself. Now it's not just medications. Remember. Anything that has a pharmacologic effect like various herbals. We can see Barberry, Goldenrod, Horsetail, licorice root, nettle, all of these actually increase the risk of chronic kidney disease. Many because there's kind of a low-level allergic reaction that occurs in the kidneys. And this allergic reaction causes inflammation and then scarring in the kidneys. So a major thing for us to consider if you're taking some sort of herbal or supplement, you want to look at the ingredients and decide: do I need to keep going with this? Is the risk really worth the benefit? Now, you may ask yourself, what is the healthiest form of nutrition for my kidneys? And it's pretty clear. Study after study over the last 20 years has shown the same thing. And that is that the more meat you eat, the more animal proteins you eat, the higher your risk of chronic kidney disease and kidney failure. In all populations, across multiple different countries, the same is found again and again. More plants, less chronic kidney disease. Fewer plants, more meat. Higher kidney disease. And what it is about the plants is that on average, people who consume more micronutrient-dense plant-based foods, right, especially in their whole unsort of processed form, they have lower rates of blood elevated blood pressure, lower rates of blood sugar abnormalities, lower rates of high cholesterol, their BMI is lower, and the list goes on. In addition, all the micronutrients in the plants help to absorb inflammation at the cellular level. So, like when I had a bunch of raspberries, blackberries, and strawberries earlier, or when I had my greens with some pineapple earlier, right, all those foods are broken down in my body and then metabolized and absorbed and flow through my body. And the debris, the end products of these foods have powerful anti-inflammatory effects. And so that then circulates through my bloodstream into my kidneys, right? And has positive effects on the nephrons. Unlike when you and I consume more of the animal-based foods, these have very, very negative effects. This is why, if you're familiar with if you've ever been in a hospital or worked in a hospital setting, you've heard the physicians, let's say someone comes with a chronic kidney disease or kidney failure. what do they put on right away? A renal diet. And what is a renal diet? It's a very low protein diet, right? So that we're not overwhelming the kidneys. And so it turns out that the animal proteins in particular are very toxic. Plant proteins don't seem to have the same negative effect on the kidneys. But still, if somebody is in a state of chronic kidney disease, especially stage 2, 3A, 3B, and we're wanting to reverse that, we're going to go with a relatively low protein diet and a very high micronutrient diet. So this is the good news for you and for I is that there's a lot we can do. At the tip of our fingers and our forks, choosing what we put on our plate can radically influence our risk. So Animal sourced proteins is detrimental to kidney health versus plant-based source of proteins is not. So we want to keep that in mind, right? So, how would that plant-based diet be kidney protective? Well, as I mentioned, reducing obesity, blood pressure, cholesterol, improving glycemic control. People who are eating a plant-based diet on average need fewer chronic medications, less total animal protein, and of course more water. All of these are kidney friendly. So that kidney friendly diet is high fiber, high water, low animal protein, and high polyphenols and micronutrients. And this is where you and I can continue every day to maximize our nutrition. Even if we're eating no ultra processed food, minimal to no meats, et cetera, we still want to maximize what we're consuming, right? More berries, more greens, more of the fresh herbs, more of these micronutrient rich foods, getting the beets in there and the arugula and the watermelon and the you know the list goes on. Each of these have different micronutrients in them, different forms of polyphenols in them that are powerful for our kidneys. An area that you may not think enough about is hydration as well. So taking a look at your urine, making sure that it's relatively clear with a slight yellow tinge, not deep yellow, burgundy or burnt brown, etc. Making sure that your urine does not smell abnormally. And that you don't have any burning or discharge when you're urinating. If you do, you want to then be evaluated, have that urine tested. Do you have an ongoing urinary tract infection? Because remember, UTIs can ascend up and cause paline nephritis, which is infection of the kidneys. And so we need to treat and address any underlying kidney, pardon me, urinary tract infections so they don't get up into the kidneys. Because when they do, that can create scarring and injury. So, your to-do list when it comes to healthy kidneys is to know your body mass index, your waist step circumference, to check your blood pressure at least once a month, but if it's elevated daily, check your labs once a year, including a good C B C, CMP, and of course other basics like vitamin D levels and thyroid function, just to name a few. And every day check your fridge and your pantry, because that's where health starts. We all have to eat the choices we make every meal. Every snack can radically influence the health of our kidneys. With that, I want to thank you very much for joining me today. And I look forward to seeing you for another NHH Day podcast where we can sit and chat and learn together about where health really comes from. Look forward to seeing you again soon.