PowerLiving with Kimberlee Langford
PowerLiving with Kimberlee Langford
How a Ketogenic Diet Can Improve Kidney Function
Experience a transformative conversation in this episode as we dive deep into the promising intersection of ketogenic diets and kidney health featuring renowned experts. Dr. Thomas Weimbs and Dr. TJ O'Neill illuminate new findings that challenge conventional wisdom, including innovative strategies for managing chronic kidney disease through nutritional interventions.
Together, they discuss the clinical potential of ketogenic diets, which not only focus on protein and fat ratios but fundamentally shift how we view food's critical role in healthcare.
As they explore fascinating clinical trial results showing improved kidney function in polycystic kidney disease patients, you’ll gain insights into the science behind these promising developments. They challenge outdated dietary restrictions and shed light on the importance of protein intake for preventing muscle wasting in kidney disease.
This episode serves as a wake-up call for patients, caregivers, and healthcare providers to embrace informed dietary strategies that could reshape lives. Join us in this important discourse on treating chronic conditions and find out how you can harness the power of nutrition in your own health journey. Don’t forget to subscribe, share this episode, and leave a review!
For more information on our guests:
- Thomas Weimbs, PhD: www.linkedin.com/in/weimbs and www.santabarbaranutrients.com - leads a research team that is proving that food and nutritional medicine can pack a punch at incredible savings - particularly for folks with polycystic kidney disease (PKD) and related renal diseases.
- T.J. O'Neil, MD --the hardest-working retired nephrologist I know. Brilliant Nephrologist, Air-Force Nephrologist, Medical Director Veteran, Inventor, Speaker and Educator. www.linkedin.com/in/tj-o-neil and lifebloodfoundation.com; www.aakp.org/aakp-innovator-series-hd-clean-llc/
Okay, we're rocking and rolling. Welcome, welcome.
Speaker 2:Yeah, hi everyone. My name is Thomas Wimes. I'm a professor at the University of California in Santa Barbara and we have been focused on researching polycystic kidney disease for something like 25 years, and we've also recently launched a company called Santa Barbara Nutrients out of the university. The company makes what's called a medical food called KetoCitra, containing exogenous ketones and citrate and a few other things, and it's meant for chronic kidney disease, including polycystic kidney disease. We've also created a nutritional intervention program called the Renew program for people with polycystic kidney disease, where they can learn how to implement a kidney-safe, ketogenic diet while taking Ketocitra, and it's a three-month program and you know we can talk all about it if you like.
Speaker 1:I think this is super exciting because it's pretty controversial in the nephrology space we were talking a little bit before because usually when you talk about a ketogenic diet, nurses and nephrology docs because you know, unfortunately most people really don't follow a true keto diet. They just go eat a whole lot of meat and throw themselves into an acidotic state and which intakes their kidneys. So really excited to see this research that you're doing. Matter of fact, can you share just a little bit about the clinical trial that you've got going on right now? I think that's really exciting and really like to see those papers. You've got quite a bit out there already research out but would you mind sharing just a little bit about that.
Speaker 2:Yeah, absolutely. So we actually already published a clinical trial about a year ago. There was a randomized controlled trial done in Germany at the University of Cologne on people with polycystic kidney disease and they were randomized into a control group versus a ketogenic diet group. Only three months intervention, so pretty short term, and it was really meant to be a pilot study looking for safety, feasibility and so on, but to our surprise there was already an efficacy signal.
Speaker 2:So the patients in the ketogenic diet actually did really well. Not only did their kidney function not deteriorate, it actually improved. So there was a statistically significant increase in EGFR and that was measured by both creatinine versus statin C. There was actually also a significant decrease in total kidney volume. So in polycystic kidney disease the kidneys grow bigger and bigger and it's a readout for the progression of the disease. So we saw a decrease which is unheard of. That has never been seen before in any other study. So that was quite amazing. And now I'm actually doing a longer term study in Tokyo in Japan, at Junten do University that's led by a professor, shige Hori, looking at a one-year follow-up and again a ketogenic diet at this time actually together with our medical food, keto citra, and the first patients are just about coming up towards the one year mark, so we're hoping to maybe look at some interim data. So I don't have the results yet. I only know that everybody seems to be doing really well and patients like to be on the diet.
Speaker 2:And so nobody has dropped out or said, oh, I can't do it. So that's very encouraging. Wow.
Speaker 1:I just got to say wow. So Dr O'Neill TJ, prominent nephrologist, we were bragging about him a little bit earlier. But he's run dialysis centers, medical centers. He's a veteran, he just can't retire. He's that good. And now he's nephrologist gone inventor, doing some really amazing things. But, dr TJ, can you share a little bit about you, your background and you know protein is such a hot topic, especially in renal circles. Maybe you can share a little bit on. You know the role of protein, and kidney disease in particular, and then ketosis.
Speaker 4:Fair enough. Well, actually born in Wiesbaden, germany, my parents were overseas with the Air Force on active duty at the time and wound up after going to Caltech. Going into the Air Force was picked up for sponsored medical training. Sponsored medical training wound up at University of California, san Diego, and then did my residency at the Air Force Medical Center in San Antonio, which was nice, because when it came to fellowship time I was able to do a year of research with Jay Stein across town from Wilford Hall, and then got assigned to the Philippines as the only military nephrologist west of Honolulu, a good six time zones from my closest colleague. So that was a quick way to learn how to organize yourself on your own. Spent three years there and came back to a place called Travis Air Force Base in California, halfway between San Francisco and Sacramento. Spent Sacramento, spent 13 years there and was fortunate enough to be able to teach nephrology and general medicine for University of California at Davis while I was running the nephrology shop at Travis Solo.
Speaker 4:And then an opening came for the hospital commander at Howard Air Base in Panama, which was located across the canal from Panama City just as things were closing down. So I ran the hospital for the last 25,000 people who were in the US military. As we left Panama, came back to Illinois and retired for the first time about two weeks before 9-11. Two weeks before 9-11 and when they started deploying people out of Travis I mean out of Scott Air Force Base in Illinois I came back in to backfill them as a government civilian nephrologist and then couldn't quit and went down to a place called Johnson City, tennessee, to the VA hospital there, the James Quillen VA, spent 11 years there and then pretended again to retire.
Speaker 4:I had seen way too many of my patients over the previous 45 years getting endocarditis, getting bloodstream infections, and you know, when you're solo you don't have the time to think about why is this happening. And the catheters were wrapped in gauze and sticky tape to protect them, but in fact there was stuff getting into the spiral grooves of the lower locks. So I spent the last few years working on a device simple enough and cheap enough to be able to enclose, protect and secure the connection between the blood lines and the catheters so that the infectious stuff couldn't get in during treatment. And in order to fund that, I'm working with a nonprofit called Lifeblood Health Foundation out in Denver, colorado, to develop an early detection patient education and mentoring program for chronic kidney disease, trying to use a multidisciplinary approach to being able to reduce that slope of GFR decline for the general population of chronic kidney disease patients. So you know, basically that's my story up to the present time.
Speaker 1:Yeah, and I love this. So we have two innovators and I think you know it's kind of exciting because there hasn't been a lot of innovation for a long time in the renal space. And what excites me a lot about you know what you're doing there, dr Wimes is you know, we know a lot of the meds. You and I have talked about that before. A lot of the meds for polycystic kidney disease we've had, you know, we've had some in a new innovation there recently, but those are so expensive, oftentimes seen as cost prohibitive, and you're talking about food, food as medicine, go figure, I think that's really exciting.
Speaker 1:But maybe you know, dr O'Neill, could you maybe share a little bit about, especially for people with late stage kidney disease. We don't and yet we have muscle wasting. We know that a lot of times they don't get adequate protein and then you know, everything that we've been teaching people about eating healthy goes out the window as they get to late stage kidney disease. And now they can't have a brand muffin but they can have Lucky Charms. When did that become a health food? And so I really think that this innovation around you know factors that people have personal control over.
Speaker 1:I am unfortunately, and fortunately, I'm 100% responsible for what I put in my mouth and how I move my body, and so I really think this research is really incredible, and not just for polycystic kidney disease, but when you think about all the pathways of inflammation, I think what you're doing is really remarkable. But maybe can we talk a little bit about um, you know why is protein such a hot topic? Um, and you know why. When we talk about a ketogenic diet, why is this seen as like a maverick approach or a revolutionary approach? You know what are the hot topics there around a ketogenic diet, in particular as it relates to kidney physiology.
Speaker 4:Well, from the general nephrologist standpoint, I come from an era where the diet training when I was in medical school was strict avoidance of protein, the Giovanni Giovannetti so-called sugar cookie diet.
Speaker 4:Basically, people looked at the BUN and the creatinine and they said hey look, if you starve people of protein, the BUN and creatinine don't go up as high. Well, if you have no protein to burn into BUN and you're developing sarcopenia from being in a chronically negative protein balance, your BUN and creatinine aren't going to go up. But by the time you eventually wind up with symptoms of uremia, the transplant surgeon looks at your tissue and says I can't sew tissue paper. It was a false algorithm for how to prevent the slope of the GFR curve from going down. Now it's been known since 1923, edison Drury that if you load on animal protein you tend to get hyperfiltration and you tend to get a increase in insulin resistance. So you know the the trick here is to find proteins that prevents our companion, that are not metabolized into acidic byproducts, that do not increase insulin resistance and at the same time are palatable to people and sarcopenia for those who don't know who might watch.
Speaker 1:is that muscle wasting that we see?
Speaker 4:Yeah, and basically the muscles just waste away if you don't give them enough protein. It's also a problem for older people with normal kidney function who don't get enough protein.
Speaker 4:So the concern among the nephrologists was the ketogenic diet. The way it was originally presented was to load on the animal protein and to ignore or perhaps they weren't aware of the problems with insulin resistance and acidosis. Finding that balance Now. And acidosis finding that balance Now. Polycystic kidney disease patients have the best survival of the advanced CKD-ESRD population but at the same time, anything that we can do that decreases the growth of those cysts and the crushing of the normal nephrons in between is a good thing. So at this point I'll pass off to Dr Wimes and say how do you see that balance? And where do plant proteins that are metabolized down to alkaline metabolites rather than acidic metabolites fit into this picture?
Speaker 2:Yeah, great questions, tj. So I totally agree on the protein restriction being very outdated and actually probably hurting patients much more than helping. And I think you're absolutely right. You kind of like if you put someone on via protein restriction you're kind of faking a better renal function, you know, by messing things up.
Speaker 2:essentially, and we're actually worsening the overall health of the patient. You know the sarcopenia that you mentioned and all the more recent studies have pretty much shown the same thing. But protein restriction really increases mortality rate and has really no benefit for renal function. So I think it will take another decade or two for that to filter down to all the practitioners out there probably, unfortunately. Yeah, and then the question now of so what about ketogenic diets? I think they are often very misunderstood. So originally, ketogenic diets are not really like meat diets, so that's not the point of it. A ketogenic diet just simply means, you know you reduce the carbohydrates, all right, so carbohydrate restriction, and you just make up the difference with the two other macronutrients. You know protein and fat and in fact see the classical ketogenic diet used for an epilepsy control and children, you know, which has been around for a hundred years. So it's it's a very old diet, it's definitely not a fat diet and that's something pretty ancient mmm and actually highly effective in an epilepsy.
Speaker 2:that one is a very high fat diet, so so it keeps the protein level, you know, kind of moderate. You restrict the carbohydrates and that's sort of a classical ketogenic diet which is, you know, a little bit hard to do forever and ever. But you know, if it saves a child from having epileptic seizures every hour or so, you so I think that's definitely worth it.
Speaker 2:Since then, many other versions of ketogenic diets have come up, with the Atkins diet, which tends to be more of a protein-rich diet, and there's modified Atkins and all kinds of versions, and we have worked on a more plant-focused ketogenic diet. I always think the you know the exact composition is maybe more up to people's tastes, um, and what really counts is the uh, the metabolic switch um into ketosis, where the body as a liver, primarily produces ketones. Um, and the main ketone, you know, is the beta-hydroxybutyrate or bhb, and which tends to be a very strong anti-inflammatory molecule. So bhb and ketogenic diets in general tend to be highly anti-inflammatory. They're beneficial in many things such as like even arthritis pain and so on, which are kind of inflammation-driven diseases, and of course chronic kidney disease is an inflammation-driven disease as well. In my lab we're actually trying to understand, you know, why ketogenic diets are so effective in chronic kidney disease and you know we probably a very big chunk of the efficacy comes from the anti-inflammatory properties and we can even kind of tease it apart in rats and mice. You know we can just simply give them exogenous beta-hydroxybutyrate, so the exogenous ketone, you know you can put it into the drinking water, or you can mix it into the food on top of just a regular rodent shower, so you don't change the diet, you just give some extra BHP and that already mimics most of the renal protective effects of a ketogenic diet, which is, of course, great, you know, if you can filter it down to one component. Yeah, and we think so.
Speaker 2:As a biology professor, you know I always think in terms of evolution and you know we humans we didn't evolve in the last 100 years, you know. Obviously we not even in the last 1000 or 10,000 years. We evolved over the last, you know, couple million years, you know, while our species was being created and our ancestors, you know, before the agricultural revolution, which happened about 12,000 years ago. Prior to that, we humans we all ate essentially mostly animal products. We were hunter-gatherers, but mostly hunters. Actually, there's some pretty interesting studies out there and I think the field of paleoanthropology is pretty much in agreement that the ancestral diet of humans that we evolved with, that our bodies are fine-tuned with, is a pretty high percentage of animal content type of diet.
Speaker 2:And also I think the importance is that humans in ancestral times were in and out of ketosis all the time because they didn't have refrigerators and food pantries and grocery stores everywhere, so people were not snacking all day long and didn't have free meals per day plus extra snacks. You know, when they were lucky and had a mammoth to hunt and got one, they had a lot to eat. But then there were lots of times where they weren they weren't as lucky, they just didn't eat. So I think that's oftentimes forgotten. That you know, as a you know, in order to keep people healthy, it's actually not a bad idea to have them eat something that is ancestrally and evolutionarily an appropriate food. So you probably can't go wrong with that approach. You know, like the zoo director wouldn't feed meat to the zebras and hay to the lions, right? So that would be a disaster.
Speaker 1:And unfortunately Doesn't food grow in a tin can or a cellophane wrapper. I mean, come on, I think so.
Speaker 2:Right, exactly, yeah, yeah. So from that point of view, I think it's actually pretty good to just fundamentally rethink human nutrition a little bit and think in terms of you know, where do we actually come from as humans? You know what is actually, what have our bodies evolved to? And you, you know? Something like a ketogenic diet is, I think, a pretty good way of mimicking the sort of the ancient way of eating yeah, you know another reason that's so attractive, you know, to me.
Speaker 1:Sometimes, you know, in different cultures that we work with too, there's a lot of food shaming. I have forbid if you, you know, you eat tortillas or rice and beans. You know, or you know, and yet it's funny because our ancestors, to your point, our ancestors didn't have, they didn't have these issues. They didn't have the rates of diabetes and obesity that we're seeing and inflammation from all these factors. And I love what Jasmine said too, that intermittent fasting is also very popular, especially folks who are fighting diabetes. We have a lot of folks who they, you know, they go on to Google and they read about you know some of these, but they don't really know how to follow them correctly, and I think that can. Sometimes we think what you know, what a ketogenic diet is, and we really don't. So you were going to say something, I think, dr O'Neill.
Speaker 4:Yeah, Dr Weems, I'm fascinated because your studies with polycystic kidney disease patients have clearly shown that the volume of the cysts does not go up as quickly, that you don't get that as rapid a growth of the cystic kidneys. Is there direct evidence that the beta-hydroxybutyrate, the BHB, is actually inhibiting the transport of fluid and electrolytes into the cysts as a primary driver of that observed effect?
Speaker 2:Right, yeah, whether it affects electrolyte transport, I couldn't tell you. So nobody has looked at that. And I think probably the more important function of beta-hydroxybutyrate is the anti-inflammatory properties. You know it actually inhibits a complex called the NLRP3 inflammasome, so the aficionados might have heard about it. So it, pretty broadly, is an anti-inflammatory compound, which is really what you want.
Speaker 2:You know, if you're thinking in terms of, you know essentially any chronic disease, including chronic kidney disease, and that's something we're trying to tease apart in the lab. You know exactly what are the different mechanisms involved. Where BHP is a benefit, bhp, for example, also inhibits what's called the mTOR pathway. That's an important cellular signaling pathway that we already 20 years or so ago had shown to be a driver of polycystic kidney disease progression. And you can inhibit mTOR with drugs, of course, with something like rapamycin, which really knocks it out. But you can't do that in people because rapamycin is just way too strong. You know it's actually an immunosuppressive drug and you cannot immunosuppress someone, or you don't want to immunosuppress someone for the rest of their life if they don't have to. So clinical trials were done with rapamycin, for example, you know, based on animal studies, and you just couldn't get high enough doses into people for long enough time to have the same beneficial effect.
Speaker 2:But the food restriction, the ketosis, is almost like a natural way of achieving the same goal without any of the side effects. So I'm really thinking you know that's the way to go. The good thing is it's highly accessible to anyone in the world. You know you can be in ketosis, you know, in the poorest village in Africa if you want to. It doesn't cost you anything. But it also is a bit of a downfall, because this makes no one any money, unfortunately. So you essentially don't even need a doctor anymore. Anyone can put themselves on a ketogenic regimen. There's nothing prohibiting people from eating whatever they want to eat.
Speaker 2:Don't tell big pharma well, yes, so they're not. And you know, as you probably know, um, you know, 90 plus percent of the clinical research is funded by big pharma in the us and pretty much worldwide, right, so all the clinical trials, almost all of them, are funded by, for you know, those are pharma trials. You know, drug versus placebo um, nobody will ever want to fund a trial. You know, ketogenic diet versus control diet at least you know not anyone with lots of money. Um, yeah, so that's a bit of that makes things a little bit slow. And you know, struggling always know rounding up research funds for studies treatment.
Speaker 4:The big dialysis services providers have said we're not interested because it would add a small amount to every one of the 15,600,000 treatments a year that we give to people with catheters and we don't want to spend the extra money. On the other hand, if your dietary approach can slow that curve, it would seem that CMS would be very interested because they pay the bills for this epidemic, if you will, of end-stage kidney disease, are interested in backing this kind of research and intervention.
Speaker 2:Right? Great question. I would say we'll have to wait a few days for the dust to settle because, as you probably have heard, there is a whole new over there and people are getting fired and new people come in and nobody currently knows which direction things are going to go, are gonna go, but you know there is a chance that things might actually change for the better. You know you never know. Fingers crossed and force by for the better. I actually mean you know preventative approaches, right. So why spend all the money on dialysis if you can simply prevent people from ever needing dialysis right in the place? Seems logical, seems good, of course, for it is a huge blow to financial profits and if no clinic and no dialysis center has any more revenue, they will all go under. So there are financial incentives you need to keep the system the way it is. So, unfortunately.
Speaker 1:But I say play along or step aside.
Speaker 2:Yeah, I think you were cutting out for a second Kimberly, but I think you said something like bring it on or something.
Speaker 1:Play along or step aside. But you're right. I mean, that's where the money is. So you know. It's interesting. Nobody thinks that there's money in prevention, and I beg to differ. There's good money in prevention. Um, it's just. Yeah, there's a lot of. Bob dylan would say. There's a lot of forks and knives at the medical table, so to speak, and they got to cut something.
Speaker 4:So hey, Dr Williams, I had a question about the different ketogenic diets. You've looked at them and obviously you've studied the balance of metabolic responses to different ketogenic diets. One of the things that is associated with increased loss of kidney function is a decrease in serum bicarbonate and, depending on the balance of animal and plant protein, you can drive that serum bicarb one way or the other. What have you found about the relationship between the different diets and the serum bicarb of the people that are eating them?
Speaker 2:Yeah, that's a great question. So it is true that a ketogenic diet is a bit acidifying, typically, you know, because you're essentially turning a neutral triglyceride into you know, acidic ketones, um, so there's an, especially in the initial transition, you know, there tends to be, you know, more urine acidification, for example. That's actually something we're we're trying to mitigate with this medical food that we developed, ketocitra, which is an alkaline formulation, so it actually raises urinary pH levels back to more normal, neutral values. It would increase the bicarbonate buffer in the blood exactly for that reason, and you're also absolutely right. So even in polycystic kidney disease, there have been studies showing that, you know, the lower the bicarbonate, the worse the progression of the disease. So I think that makes absolute sense to make sure we're not acidifying the patient forever and ever, but have something to, you know, to offer them.
Speaker 2:You're also probably right, you know, both, a more plant focused diet, you know you can shift that balance, um, um. But then you know, one has to be very careful not to introduce um certain other problems such as things like oxalate and so on, which is something we also have actually researched in the lab and we found that oxalate is really detrimental in something like polycystic kidney disease. So we can give rats oxalate and we can really drive their polycystic kidney disease forward pretty dramatically. So there's a you know plasma is under. Actually all the medical food also addresses the oxalate because it contains citrate, you know citric acid which prevents the formation of calcium oxalate, micro crystals, microcrystals and kidney stones.
Speaker 4:Yes, Now, another thing that is different between plant protein and animal protein-based diets is the phosphorus absorption In the animal proteins. The phosphorus is very bioavailable. In plant proteins it's bound up in phytates which have a very low absorption. So in adjusting these ketogenic diets and changing the balance of protein, have you seen anything with respect to protecting against the hyperphosphatemia that drives the hyperparathyroidism and the bone loss?
Speaker 2:Yeah, great question. So we Americans, you know, on a standard American junk food diet you know all pretty much get too much phosphorus in our diet, phosphorus in our diet, and.
Speaker 2:But I would actually argue that most of that evil, so to speak, comes from the ultra processed foods, because they usually contain a lot of food additives.
Speaker 2:You know, phosphate food additives for and not for nutritional reasons, right? So they don't put it in there to be a good nutrients, they put it in there for chemical reasons, right, to have the um. Their products, you know, work better, be manufactured easier, live longer on the shelf and so on. So by just simply cutting out all the ultra processed foods, um, and americans eat up to up to 80 percent of the caloric intake comes from ultra-processed foods these days for many Americans, which is just, I think, an insane number. But just cutting out ultra-processed foods and go whole foods, I think you're already reducing phosphorus intake pretty dramatically, and I don't think it matters too much anymore whether somebody eats more animal whole foods versus plant whole foods. By just simply cutting out the ultra-processed foods, you're already probably achieving a lot of the benefits there Nevertheless. So one feature of this medical food, keto-sitra, is it's formulated with calcium in there, and the calcium actually acts as a binder for extra phosphorus and for inorganic phosphate food additives, for example. So that's also meant to reduce the phosphorus intake as well.
Speaker 4:Okay, Um, now how about, as you said, you only have two substitutes for carbohydrates? You've got protein and you've got fat. What happens on a ketogenic diet with regards to hypertriglyceridemia and the fat metabolite issue?
Speaker 2:Right. So in general all the lipid values usually improve in most patients, so everything gets better. Triglycerides, hdl the only thing that can bump up and that most of the time is sort of temporary, that's the LDL, the LDL cholesterol numbers. Whether that is of any consequence, I think most people would say it's not. There's some new studies coming out now where people actually have fairly high LDL cholesterol values for long, long times. Nothing bad happens to them. And in fact you know, if you lower ldl cholesterol kind of artificially with drugs, too, too low, that is probably even detrimental to people in the long term. So there are reasons maybe to think that you know starting therapy, you know, may not really have the outcomes that people are hoping for, but so in general with ketogenic diets, you know, all the lipid, the entire lipid profile improves.
Speaker 4:Okay, are there any biopsy studies? And in polycystic kidney disease that would be difficult that look at the white blood cells, the inflammatory cellular infiltrates. When I did kidney biopsies on non-polycystic kidney patients, I want to emphasize that I would see, even in relatively modest chronic kidney disease, these nests and fields of inflammatory cells, lymphocytes and polymorphonuclear lupus white blood cells that were in there in an inflammatory mode. Is there anything to suggest that this induction of beta-hydroxybutyrate in the polycystic patients leads to a decrease? In those inflammatory infiltrates that you can actually see on a microscope.
Speaker 2:Great question. So that's exactly what we're doing in the lab at the university. And, of course, like you said, um, you can't really do this in humans. You know you don't want to biopsy people, um, but you can easily study this in rats and mice.
Speaker 2:So that's what we're doing um and you know we're seeing some and we've actually already published this um. So on a ketogenic diet, pretty much all the inflammatory cells in the the kidneys go down, the macrophages in particular, which are usually really prevalent in the system kidneys. You put the animals on the keto diet and they're they're vanish, they disappear. Um, we do have some interesting um data that's actually not published yet. So it's still.
Speaker 2:You know, you're the first to hear about it. You know you can look in the blood at lymphocytes and neutrophils and you can calculate the NLR, the neutrophil to lymphocyte ratio. And you know, one thing we found is that neutrophils are actually part of the inflammatory response in polycystic kidneys, seem to be drivers of disease progression, and you can also see this in the blood and in the clinical study. We have already published one thing we hadn't published yet, and this was all done by our colleagues in Germany at the University of Cologne. One thing we haven't published yet is the effect of a ketogenic diet on the blood neutrophil to lymphocyte ratio, and it actually improves it. So you put people on a three-month ketogenic diet and the NLR value goes down, suggesting the effect that we were hoping for on the immune system.
Speaker 4:Fascinating, fascinating. Okay, where is the research that you're doing? What directions, based on the findings that you've had so far, are you going in now?
Speaker 2:Yeah, so we're doing sort of two things in my academic research lab at the University of California in Santa Barbara. We're trying to really look at all these mechanisms that we have already mentioned. Why does BHP really do, what's the effect on the immune system, and so on. We're also looking at the whole microcrystal aspect of things, you know, which is sort of like a second mechanism that we had discovered that can drive polycystic kidney disease progression. So there's a lot going on.
Speaker 2:We have recently focused on uric acid and that's actually a manuscript we're putting together, hopefully can send out for publication soon. But we found that uric acid is really an important driver of disease progression, and probably not only in in pkd but also in particular in something like diabetic nephropathy, because usually uric acid levels, you know, are just just as high as you know anything else. You know syndrome, type 2 diabetes and so on. And what uric acid does is it tends to precipitate in the form of microcrystals in the kidneys, especially under acidic conditions. When you have a low urine pH, you pretty much are guaranteed to have uric acid microcrystals forming and that cause inflammatory damage. So that's something we have been investigating.
Speaker 2:And then on the sort of the company side, you know. So, as I mentioned, I'm also the president and chief scientific officer of Santa Barbara Nutrients, our startup company. Through the company, we're doing all the clinical research with collaborators throughout the world, academic collaborators. We have one study, for example, that will hopefully start in a few months at the Cleveland Clinic, looking at three-month outcomes of, again, ketocitrara, both ketogenic diet, focusing on metabolic outcomes, which is something you can actually measure much faster than renal outcomes, so that will hopefully start soon, and we have sort of like a whole pipeline of additional clinical trials lined up.
Speaker 2:One of them, for example, would like to look at late stage polycystic kidney disease you know, people that are getting closer and closer to needing dialysis to see if a ketogenic diet can essentially either bring them back from the brink or at least stabilize them for some time, which that would be amazing. You know, so far we only have anecdotal feedback from customers, you know that have done it, and and clients and people we know, um, that have done it and it seemed to work well for them. But you know, obviously we want to have a nice controlled study there as well.
Speaker 2:Now I want to see that with lupus and RA and MS Right yes exactly so yeah, we're really very interested in essentially all forms of chronic kidney disease, diabetes Exactly that's a big one the diabetic nephropathy. So we're gearing up putting together a grant proposal looking at type 2 diabetes, chronic kidney disease. And again there's a new sheriff in town at the federal level, so nobody currently knows what is going to get funded going forward and what's not going to get funded. We'll see what happens. Not going to get funded.
Speaker 1:We'll see what happens.
Speaker 4:Well, certainly all of this valuable information needs to get out to the dietician community, because they are going to be the ones who interact with the patients at the eye to eye, eye down in the trenches level. How do you?
Speaker 2:see that effort going. That is a big challenge.
Speaker 1:If the facility will allow them to.
Speaker 2:Exactly, that's right. So I think there are many challenges because it has been, you know, for decades and decades the teachings have been just, I think, upside down of what it should be. We all know the food pyramid, which has the carbs very prominently at the bottom. It's supposed to be the main staple of our diet, without anyone realizing that the carbs are, of course, course, what gives you chronic kidney disease, right? So the type two diabetes, ckd, diabetic nephropathy, comes from the carbs, because that's what, what's giving you the type 2 diabetes.
Speaker 2:So I'm not quite sure why that isn't clear to anyone, um, but, um, you know, it's just backwards, you know to me, right? So anyone who, um you, who is at risk for diabetes or at risk for chronic kidney disease should obviously not be on a high-carb diet. That's the last thing you would want, but it's just so backwards currently, and I think it unfortunately takes courage for people to say, oh, wow, you're right. I have been doing it wrong for my whole career and have given people the wrong advice, you know, and nobody ever wants to admit that and change course. So, like they say, medical medicine progresses one funeral at a time.
Speaker 2:So that might be one of those cases or at a time. So that might be one of those cases.
Speaker 1:So what about? What about? For? You know, because patients, individual members, they often I would say probably wouldn't you agree nurses one of the most common questions we get is what am I supposed to eat? Or they read about a diet that they saw on Pinterest or whatever, and that's where they're getting their information. So, between the MD and the PhD here, what would you say for somebody who either has kidney disease or has a health condition like what we've been talking about, or somebody who loves somebody who has these kinds of things? Where do they go to find? Because, to your point, and for a long time, it was six servings a day of this stuff, right? So, um, where do they go, uh, to find a reputable source? I, we know we always have them talk to their doctor and we know doctors don't get much education on nutrition in med school. So where would you say doctors, where would you say people, go to find reputable information that they can put into practice?
Speaker 2:Well, if you're asking me, it's actually really hard. There's no point looking at medical textbooks or nutrition textbooks. I have a whole stack of nutrition college and graduate level textbooks in my closet there and they're all completely useless, very outdated Currently. I think the best information is really essentially out there on YouTube, if you will. If you will, um, that's um how you can learn certain things.
Speaker 2:Reputable sources on youtube there are yes, but there actually are quite a number. There's a few grassroots movements I'm part of um, for example, an organization called the keto life organization as a kind of centered in Europe's. I have an annual conference that's coming up in June, so I'm gonna be there. In Switzerland there's a, you know they're trying to build up CME accredited courses for doctors so that doctors can actually just sign up and learn something that's not sponsored by Big Pharma, but it's not easy. And there are some low-carb, keto type of symposia and conferences. Also in the US there's one called the Metabolic Health Summit. That was usually every year. I think this year they skipped it, so hopefully there'll be another one coming up soon. And you know there's like several others like that.
Speaker 4:I'm involved in an effort to try to get information like this out. You know, notice conflict of interest. I am a consultant to a group called Lifeblood Health Foundation out of Littleton, colorado, and we're trying to build a set of websites that start with what is your EGFR? Is it what it should be? At your age, you have excess protein in your urine. Give patients with very little uh, medic, formal medical literacy, if you will, information about what their risk is so they can go to their health care teams and say, uh, hey, uh, my gfr is 15 mils per minute below what it should be.
Speaker 4:At my age I've got protein in my urine. Nobody's talked to me about this. Help me. And as this effort proceeds, the goal is to have dieticians, mentors, to get this information incorporated into this wraparound web-based educational program so that it will be available through the healthcare practices who will subscribe patients to it and they will be able to basically follow their kidney condition from diagnosis hopefully not to dialysis, but track their kidney function. Get the diet information that is real, that is current, and get dieticians and nurse educators who are connected to that information in touch with these patients very early in the course of their disease stage 2b, stage 3, when you've got enough altitude above dialysis that you can intervene and you're not down here with your provider saying, gee, I'm sorry to tell you this, but you have to go on dialysis. That's not when you need to learn the kinds of things that Dr Weems and others are trying to teach.
Speaker 2:Perfect. Yeah, I think that's actually great early recognition of chronic kidney disease and it's so easy to do. I don't really quite understand how it can happen that somebody shows up at an emergency room.
Speaker 1:All the time. Yeah, if I had a dollar for every time. Somebody said, how come I'm just not here in this and I'm told I need dial. I could retire. Yeah, somebody said, how come I'm just not here in this and I'm told I need dial?
Speaker 4:I could retire. And the sad thing is that a group called the US Preventive Services Task Force, uspstf, which approves tests for Medicare and Medicaid funding, has never identified chronic kidney disease early diagnosis as being cost effective, and so it's not paid for as a routine chronic test. And that albumin to creatinine ratio that's the gold standard of knowing whether your kidneys are leaking protein because of either inflammation or hyperfiltration never gets done until they're in stage 3b or, worse, 4. And then you've got very little time to pull back on the stick and keep that plane from crashing into the runway. Right, yeah, plane from crashing into the runway Right.
Speaker 1:Yeah, very good, very delicious conversation and I took down some resources. People can look into Keto Life and the Metabolic Health Summit that you mentioned, lifeblood Health Foundation and, of course, you know you can certainly look up Dr Wimes and UC Santa Barbara. Now I had it and I changed screens. What's the name of your company again?
Speaker 2:Santa Barbara Nutrients.
Speaker 1:Santa Barbara Nutrients. She just want to go there and, like, have a nice sandwich. Santa Barbara Nutrients. You can certainly find out more information. I'm going to put that here in the chat as well. So if you're not following Dr TJ O'Neill, you probably want to. He does some really great things, and if you're not following Dr Weems, you probably want to. You both just acquired a whole bunch of new fans and I know from speaking for all the nurses, we all really appreciate the time and your expertise and your knowledge that you shared today. Thank you so much for taking that time.
Speaker 2:Wonderful. Thank you, Kimberly.
Speaker 1:Thank you.
Speaker 4:Thank you, thanks, kimberly.