Shireen Abdullah  0:01  
In this eye-opening episode, we dive into one of the most overlooked complications of diabetes, kidney disease, and explore what it really takes to catch it early, manage it effectively, and protect long-term health. Dr. Katherine Tuttle breaks down the science in clear practical terms, sharing the early warning signs most people miss. The role nutrition and culture play in kidney health and how to make meaningful changes without sacrificing the foods you love. She also highlights what healthcare providers and communities can do to offer better support and leaves listeners with an empowering message that you can act on today. This conversation is packed with insights, encouragement, and real-world strategies, you won’t want to miss. Stay tuned. 

Shireen Abdullah  0:51  
Podcasting from Dallas, Texas. I am Shireen, and this is the Yumlish Podcast. Yumlish is working to empower you to take charge of your health through diet and exercise and reduce the risk of chronic conditions like type 2 diabetes and heart disease. We hope to share a unique perspective and a culturally relevant approach to managing these chronic conditions with you each week.

Shireen Abdullah  1:23  
Dr. Katherine R. Tuttle is Executive Director for Research at Providence Inland Northwest Health and Professor of Medicine at the University of Washington. Her collective body of work has shaped the pillars of therapy for diabetes and chronic kidney disease across the spectrum of scientific discovery, clinical trials, and population-level implementation. Welcome. Dr. Tuttle.

Dr. Katherine Tuttle  1:50  
Thank you so much. It’s a pleasure to join you. 

Shireen Abdullah  1:52  
Such a pleasure having you on, but before I dive into the topic for today, which is around diabetic kidney disease and prevention. Can you tell us a little bit about what just really drew you, personally, to focus your research and your clinical work on kidney disease in particular?

Dr. Katherine Tuttle  2:10  
Yeah, that’s a great question, because I started out in endocrinology, and I’m also trained as an endocrinologist as well as a nephrologist, and in those early days, we were studying a lot about the physiology of diabetes. How glucose levels were regulated physiologically. And the studies included a lot of young people with type 1 diabetes. And to do these studies, they were very complex, we used a machine called the artificial pancreas. It was the biostatter, and today people will wear a closed-loop glucose monitor and insulin infusion set on their belt. But in those days, the machine filled an entire room, and these people volunteered for experiments because they thought that this work would somehow improve the plight of people with diabetes. 

Dr. Katherine Tuttle  3:03  
And I suppose it did, because a lot of the physiology led to the treatments that we now use. However, there was a real blindness to complications at that time, and no pun intended about retinopathy, but we’re talking about 1985. And one of the people who participated in the trial, I was about the same age as they were, and spending eight hours in a room, just, you know, the two of you, you get to know each other quite well. I considered many of them friends, and one of them crashed into dialysis at Barnes Hospital and didn’t live very long after that, and I realized that we hadn’t even been thinking about complications, and particularly kidney complications, and there was very little awareness, very little knowledge of how these complications occurred, and almost nothing was being done about it. And I just felt that something needed to be done, and I didn’t know what I was going to do, but I decided to go on and do additional fellowship training in nephrology and really focus on understanding how diabetes affected the kidney, and then that as a basis for developing interventions. That now have really delivered in terms of not only saving kidneys, but also hearts and lives.

Shireen Abdullah  4:26  
How fascinating, in what shaped like having that experience really shaping where you went professionally in your career here, which maybe is a good starting point as well to help us understand a little bit about diabetic kidney disease and why it is such a critical complication of diabetes. What is that relation there?

Dr. Katherine Tuttle  4:47  
So diabetes is now the most common cause of chronic kidney disease that leads to kidney failure in the entire world, and it affects every region of the world, both people with type 1 and type 2 diabetes. Now type 2 diabetes is responsible for 90 to 95%, depending on where in the world you live, but both complications lead to kidney disease in many people: 4 of 10 with type 2 and even today, 3 of 10 with type 1. It is among the most common complications, yet among the least recognized and detected. We’re doing better than in 1985, but still, there’s a real lag behind other important complications. Many people are very aware that diabetes is a major driver of cardiovascular disease, and it absolutely is, but the kidney complications have not received the same attention. And another interesting twist in that story is that almost all the excess cardiovascular risk is in the subset with kidney disease. 

Dr. Katherine Tuttle  5:51 
So it turns out, we did the study many years ago. If you look at large nationwide samples, for example, the National Health and Nutrition Education study, or NHANES, which you and some of your audience may be familiar with, that we used to study a lot of chronic health conditions in the population. We actually looked at that whole population with diabetes, and the group that had no kidney disease had a minimally increased risk of cardiovascular disease over the non-diabetes population, and the earliest sign of kidney disease, albumin in the urine, tripled the risk. Low kidney function, measured by high serum creatinine or low estimated GFR, which you may see in your lab reports, took it up another sixfold.

Dr. Katherine Tuttle  6:37
And if they had both the cardiovascular risk, and I’m talking cardiovascular death. So hard endpoints was increased over 30 times. So that becomes, that is the intersectionality of these complications.. So what we really need to understand it’s not just diabetes driving cardiovascular risk. It’s the kidney disease and the setting of diabetes. That’s gasoline on the fire for cardiovascular disease. So they’re very integrally related in terms of the biology, but now in terms of the treatments, as well, the treatments that we’ve developed work for both complications.

Shireen Abdullah  7:12  
I do want to talk about the treatments in just a second. Just to talk about some of the early warning signs for people. I guess the question becomes, what are some of the early warning signs that people should watch out for before kidney disease turns into something serious for them?

Dr. Katherine Tuttle  7:30  
And this is one of the most challenging aspects, because kidney disease is mostly silent until it nearly kills you. It truly is a silent killer. So to be honest with you, there are very few symptoms, and the symptoms that do occur, people write off to other things. They’re tired, they may be a little nauseated, maybe they’re a little foggy-headed, but it’s not like you get a pain in your kidneys that tells you your kidneys are sick. And in some ways, it’s sort of a silver lining of the fact that the kidneys have such a remarkable ability to compensate when they’re damaged that they can compensate and maintain enough function to keep you alive until they sort of give up their last scaff? So unfortunately, people would not necessarily know, and those kinds of symptoms are so vague that they could be due to a lot of different things. So the bottom line is this: all people with diabetes need to be tested for kidney disease annually by their healthcare professionals, and it’s two tests. 

Dr. Katherine Tuttle  8:37  
It’s a urine test for albumin, it’s a marker of kidney damage, usually the earliest marker, and then a blood test for creatinine for estimating GFR, which is a complementary measure of kidney health. It’s how well the kidneys can filter the blood. Damage causes loss of function. So first we see high albumin in the urine, and then we typically see the kidney function measured in EGFR decline, and so the one thing I would say is in type 1 diabetes, where we can pretty much time the onset, it’s usually an abrupt onset. Screening should start after five years, because it takes about that long for damage to occur. In type 2, we recommend screening from diagnosis, because many people have had diabetes long before it was recognized, and it travels with other risk factors like hypertension. But truthfully, that’s the only way we can reliably detect kidney disease early enough that both even lifestyle interventions, which I know is an interest of yours, as well as medications, are likely to be effective.

Shireen Abdullah  9:42  
Which takes me to the next question. Which is, as you knew, coming about, and you learned that there’s been damage here. Is some of this damage reversible from kidney disease, or is the goal really to slow down progression? I mean, where does one go?

Dr. Katherine Tuttle  9:58  
So that is really an important question. So until recently, you know, our best success was slowing progression. That means we didn’t think we could turn it around, and we just tried to delay onset of severe complications like cardiovascular events, premature death, and kidney failure. But that wasn’t very hopeful. It sort of is like you’re on a slow-speed crash instead of a high-speed crash, one of my patients said to me. But what I would say is the last five years have completely revolutionized the field. We now have highly effective therapies that, like I said before, that save kidneys, hearts, and lives, and I am really promoting a change in lexicon to quit saying “slowing progression,” because these treatments are so effective that people actually can get better, or at least not get worse, and maintain their current level of function. And I think for our patients, that’s really important, because it’s a much more hopeful message, which means you can stick around and you can stay pretty healthy with the interventions we now have.

Shireen Abdullah  11:08  
How fascinating. We talk a lot about food and culture here at Yumlish. What role does nutrition play then, in protecting kidney health for someone living with diabetes?

Dr. Katherine Tuttle  11:21  
Well, healthy lifestyle, including nutrition, but also physical activity, avoiding tobacco products, maintaining a normal weight are really the foundation of good diabetes care and good kidney care. There is no doubt about that. And in fact, in people with diabetes and even people without diabetes who maintain a healthy lifestyle, that’s your best defense against both diabetes and kidney disease, is what we would call primary or even primordial prevention. “Primordial” means even preventing the risk factors like diabetes and hypertension. And then primary prevention means in people who have, let’s say, diabetes or high blood pressure, not developing kidney or cardiovascular complications. 

Dr. Katherine Tuttle  12:10  
But as you probably know, that is a real challenge for a lot of people, and, you know, and this is not a blame game. It’s not that people don’t want to have a healthy lifestyle, but a lot, a lot of things in our culture do not support a healthy lifestyle, whether it’s expensive food, the good food is expensive, built environments that make it hard for people to stay active. So I want to acknowledge that I think this is a social and cultural problem that has a health consequence. So of course, we promote those things, but we need to acknowledge it’s not always a matter of willpower. A lot of it is very situational, depending on where and how people are able to live.

Shireen Abdullah  12:58  
How can individuals make these types of lifestyle nutrition changes and, you know, do it in a way so that they’re not giving up flavors and traditions they love, because that is sometimes the challenge?

Dr. Katherine Tuttle  13:13  
Well, I can give you a great example of that, and now I’m going to go into what we call secondary prevention, so people who have established disease. Many years ago, I saw a patient with a very advanced form of kidney disease, not from diabetes, but another type, and he was on immune suppressing drugs. It was an autoimmune disease. And had seen five other nephrologists and was really pretty close to going on dialysis. And he asked me if there was anything else he could do, and I said, “Well, the only thing you can do is change your diet.” And he was a chef who ran a culinary institute, so you can imagine the type of rich foods and all that that he was constantly exposed to, but he really took it to heart and had the resources because he had nutritionists and all kinds of people around him who could support him in this journey. And for kidney disease, one of the most important things is limiting dietary protein, which is an interesting topic because so many people push high-protein diets. 

Dr. Katherine Tuttle  14:24  
Well, it turns out that that’s gasoline on the fire at kidney disease, particularly meat protein. Now you need enough protein for health, but we’re talking about not avoiding excess. So this individual probably took it farther than I could have even imagined. But he went on a vegan diet. He started swimming regularly. He lost 60 pounds. The bottom line is this: over one year, we were able to taper him off all the immune suppressing drugs. And not only did his kidney function not get worse, he got better. He’s maintained this lifestyle. He’s now a very well-recognized chef in the kidney world, and I can say it because he’s a very public chef, Duane Sunwald. He writes the Kidney Cuisine blog on the National Kidney Foundation website. And Chef Duane has been in remission for 20 years. He has normal kidney function now, and I have no doubt that in his case, he did turn around with healthy lifestyle. Now, one of the things I want to be clear about is not everyone’s going to be able to do that, and not everyone would respond like Duane. We are all very different, and some people in some diseases are more responsive than others. But the point is, it is possible, and it makes a difference, and even if you have to take medicine, it won’t be as much if you can really follow a healthy lifestyle, but it does require commitment and resources.

Shireen Abdullah  15:50  
And that’s just it. And by the way, I just absolutely love hearing stories like that where someone is able to, you know, go into remission in the way that he did. And we’re by the way – just for the listener, we’re working on getting Chef Duane on the podcast as well, so hopefully we’ll be hearing from him pretty soon. But when you hear about these stories, it’s very = it seems very promising, and it sounds, you know, obviously promising. And I think to what you said, which is like, it’s not a one-size-fits-all. One person can do it doesn’t always necessarily mean everyone can do it. Where do you or, I guess, help us understand, how do you meet individuals where they are to be able to empower them to make the choices that they can make, or they’re willing to make, or they have the resources to make. I mean, how does, yeah, how does a provider like yourself help individuals?

Dr. Katherine Tuttle  16:42
Well, sort of the lingo in our world is shared decision-making, right., It’s reviewing their case or clinical situation and what the options are and ask them what’s going to work for them. I think the one thing I would say, because I do think this is really important, is that in people who have diagnosed established kidney disease, almost all are going to require medicines on top of healthy lifestyle, because once it gets to that point, it’s not a competition; it’s and both. And compared to when Duane started his kidney journey, we’re in a very different place, and particularly with diabetes, we don’t use immune suppressing drugs, and the drugs that we use actually improve metabolic health as well as overall health, and they are safe.

Dr. Katherine Tuttle  17:33  
So I want people to not be afraid of medicines, and I’ll just name off some names. I don’t expect you to remember them, but some of your viewers might have heard of them: the SGLT2 inhibitors, the GLP1 agonists, and then something called a nonsteroidal mineralocorticoid antagonist, and, of course, a renin angiotensin system inhibitor. Again, don’t expect you to remember that, but if you listen to this and one of your doctors says you should be on these medicines, I would just like to empower you to feel comfortable taking them. 

Dr. Katherine Tuttle  18:05  }
They are safe, they are proven, and they work together with your healthy lifestyle to maintain kidney health in the context of your overall health. So this healthy lifestyle will also improve your heart health, improve your metabolic health, and a lot of other good things too. Frankly, the diets that we’re talking about reduce cancer risk. So maybe this is just the way our bodies are meant to eat for our general health.

Shireen Abdullah  18:32  
And along the same lines, what advice do you have for people just trying to take small, realistic steps toward better kidney health every day?

Dr. Katherine Tuttle  18:41  
Well, I think one is, love yourself enough to take care of yourself. You are worth it, and you are salvageable, and we have lots of good treatment options, even in people with advanced kidney disease. I get lots of email and messages from patients who are in advanced stages, and my message to them is: Don’t give up. These medicines, on top of the foundation of healthy lifestyle, are highly effective in our own clinical practice of nephrology; our dialysis census is down 20% in the last three years. People are not, and we have more patients, not less, coming into the system. 

Dr. Katherine Tuttle  19:23  
We have a lot of people who are not even in advanced stages, not progressing like I said; they’re maintaining health where they are, and then at the other extreme, which is maybe where more of your listeners are. On the prevention side. If you do it right from the beginning, you will live a long time, even if your kidney function is mildly impaired, if you take care of yourself and take these medicines along with maintaining healthy lifestyle.

Shireen Abdullah  19:52  
To the healthcare providers, perhaps, who are listening to this episode, what can they or even community programs do to help people get the support they need to prevent kidney disease?

Dr. Katherine Tuttle  20:05
Well, first off, it starts with awareness that kidney disease is common. It’s serious, but if we detect it early, it’s treatable. And the goal is maintenance of health, not just slowing progression, and that means, and all people with diabetes, all people with hypertension, and all people with cardiovascular disease or a family history of kidney disease should be screened with albuminuria, UACR, and EGFR based on the serum creatinine. And any level of CKD is going to warrant an intervention. All what our clinical practice guidelines tell us, and it’s based on strong evidence from clinical trials, is essentially all forms of CKD should be treated with an ACE inhibitor or an ARB that’s a serine and angiotensin system inhibitor and an SGLT2 inhibitor, because these things preserve kidney function and they reduce kidney damage. 

Dr. Katherine Tuttle  20:58  
Then in diabetes, we would additionally add a GLP1 agonist, particularly in people who are overweight or obese or people with diabetes who need better glycemic control. We also have another drug called finerenone, a non-steroidal MRA. And we can use those and that agent in people with diabetes, but especially if they also have heart failure. So again, back to your question about with patients, shared decision-making also means sort of individualizing that combination depending on their particular health situation. 

Dr. Katherine Tuttle  21:32
So I would encourage the health practitioners, especially in primary care and screening and detection, and start those first two medicines. If you get beyond that, if there’s still persistent evidence of progressive kidney damage, then don’t wait too long to refer to a nephrologist. There’s a lot we can do now. It’s not like the old days where we’re just going to say, control your blood pressure and good luck. And we really need to get the message to our primary care partners that we are your partner and your collaborator, and our goal is to help you keep your patients healthy.

Shireen Abdullah  22:07
Absolutely love that. We’re rounding out; we’re coming to the end of the episode. Dr Tuttle, if you could leave our listeners with one key takeaway method for protecting their health, their kidney health in particular, what would it be?

Dr. Katherine Tuttle  22:23
Well, the most important thing is, you know, prevention upfront, and it’s the same as for other important conditions: eat good food, eat plants, don’t eat too much, stay active, maintain a normal weight, and do go for regular exams, because no matter how hard we try, we have hereditary influences as well. And if you are programmed or develop kidney disease, in spite of doing the best you can, we have treatments, and the treatments save kidneys, hearts, and lives, and the outlook is very bright. You can get better, and you can stay healthy, but the earlier we see you and intervene, the more successful that’s going to be. And so again, our mantra has become, “Save kidneys, hearts, and lives,” and we can do it now. We have the tools, and so do you, but we have to work together.

Shireen Abdullah  23:12  
Absolutely love it on that note. Dr. Tuttle, the most important question, how can folks connect with you and just stay informed of your work?

Dr. Katherine Tuttle  23:22  
Well, you can look at the University of Washington School of Medicine nephrology website. As well as our Providence Health Center website. For a lot of opportunities with regard to research. If you’re interested in participation, even if you’re elsewhere, we might be able to refer you to a site near where you live, and lots of useful information about kidney disease, and then also, particularly for patients and the general community. The National Kidney Foundation website is a wonderful source of information too.

Shireen Abdullah  23:55 
I love it. We’ll try to link everything up in the show notes for this episode so folks are able to click on it and get directed to some of these resources. With that, Dr. Tuttle, we are toward the end of the episode. It has been such a delightful conversation here with you. Thank you so much for joining us. To our listeners, thank you so much for joining another episode of the Yumlish podcast. We hope this was informative for you. We’ll end with our Ask Listener question. And you know the drill at this point, so you head over to our social media and answer this quick question, which is, how can you make one of your favorite cultural foods just a little bit more kidney-friendly without losing the flavor that you love? Again, that question is, how can you make one of your favorite cultural foods just a little bit more kidney-friendly without losing the flavor you love? We’ll continue the conversation @Yumlish on Facebook and on Instagram. Find this podcast post and comment below with an answer to this question. Thank you so much again. Dr. Tuttle, for your time. 

Dr. Katherine Tuttle  24:52  
Thank you.

Shireen Abdullah  24:55  
Thank you for listening to the Yumlish podcast. Make sure to follow us on social media. @Yumlish_ on Instagram and Twitter, and @Yumlish on Facebook and LinkedIn for tips about managing your diabetes and other chronic conditions, and to chat and connect with us about your journey and perspective. You can also visit our website, Yumlish.com for more recipes, advice and to get involved with all of the exciting opportunities Yumlish has to offer. If you like this week’s show, make sure to subscribe so you can hear more from us every time we post. Thank you again, and we’ll see you next time. Remember your health always comes first. Stay well.

Connect with Yumlish!
Yumlish Website: Yumlish
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Connect with Katherine Tuttle!
Twitter(X) URL: @KatherineTuttl8
LinkedIn URL: www.linkedin.com/in/katherine-tuttle-390871142 
University of Washington School of Medicine Nephrology URL: https://nephrology.uw.edu/ 
Providence Health Center Website URL: https://www.providence.org/ 
The National Kidney Foundation: https://www.kidney.org/