“A plant based diet tends to have less acid load, and one of the challenges with kidney disease is that kidneys excrete the acid in the blood, so a plant based diet gives you less acid than a heavy meat based diet … The evidence is suggestive that increasing the whole grains, fruits, vegetables, fiber, are all very beneficial to patients with chronic kidney disease.”
In this episode, Dr. Leisman delves into kidney disease in diabetes, including symptoms and foods to avoid with kidney disease and diabetes. She talks about how a plant-based diet can help kidney disease with diabetes and gives specific suggestions for how diabetic individuals can take control of their health to prevent kidney failure.
Dr Leisman is a board-certified nephrologist (kidney doctor) at the Icahn School of Medicine at Mount Sinai. She cares for people with acute and chronic kidney disease, and people on dialysis.
Shireen: In this episode, Dr. Leisman delves into kidney disease in diabetes, including symptoms and foods to avoid with kidney disease and diabetes. She talks about how a plant-based diet can help kidney disease with diabetes and gives specific suggestions for how people with diabetes can take control of their health and even prevent kidney failure.
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 two 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.
Dr. Leisman is a board-certified nephrologist kidney doctor at the Icahn School of Medicine at Mount Sinai. She cares for people with acute and chronic kidney disease and people on dialysis. Welcome Dr. Liesman.
Staci: Thank you so much, Shireen, for having me!
Shireen: An absolute pleasure. So, Dr. Leisman tell us, what drew you to nephrology?
Staci: Sure, as a medical student and internist, I think one of the things that I really enjoyed was solving problems and taking care of the whole patient, and nephrology offers opportunities to do both. The kidneys intersect with the heart, with the lungs, with the GI system, they, uh, they establish all of what we call homeostasis in the body, how your body stays at normal blood chemistry at normal fluid volume.
And it was really intriguing the science and the chemistry behind that. But I also have really enjoyed taking care of patients long-term and because kidney disease tends to be a chronic disease that people have for 10, 20 years, I get to know my patients very well and follow them long term.
Shireen: And so, help us understand a little bit more about kidney disease. What are the symptoms there?
Staci: Perfect. Well, I think before we get to some of the symptoms, I think a nice starting point might be to better explain what the kidneys do for people, because it's not always known. I think most people know they have something to do with peeing, but that’s maybe the extent of it.
So, the kidneys allow us to eat and drink what we want. You can imagine that every day you take in different amounts of water, different amounts of salt, different nutrients, and our body only needs some of them. So, the kidney's job is to clean the blood and get rid of all of the products that we don't need, whether it be toxins, whether it be good nutrients that we just don't need because we have too much of, or fluid. And the way that the kidneys do that is they are constantly filtering your blood. So, the blood goes through the kidneys, the kidneys, clean it and gets rid of the waste products. And the amount of the blood that the kidney cleans every day is astronomical. It's 180 liters of blood per day.
That number seems enormous. And if you can't put your, wrap your brain about what a number like that means it's approximately an industrial sized garbage can full of blood that your kidneys are cleaning every single day. There's a lot of extra in the kidneys. You have a lot of extra reserve. Its why people can donate a kidney and still do okay. Extra do very well. Um, so if I consider that 180 liters per day of blood, a hundred percent function, we really only start seeing symptoms of kidney disease when the function is about 30% of that. So, at about 30% function is when symptoms of kidney disease start arising in many patients and the symptoms can be, uh, things that the patient experiences. Itch or swelling or lack of appetite or the symptoms can be things that we see on labs or on an exam, maybe high blood pressure or low blood counts or hyper-uh-kalemia, which is a fancy way of saying high potassium levels in the blood. And as the kidney function continues to decline those symptoms and those lab abnormalities become more prominent.
Shireen: Interesting. And so, help us understand what are some of the causes of chronic kidney disease and why is there such a prevalence of kidney disease within diabetes?
Staci: Sure, so that as you just alluded to the number one cause of chronic kidney disease and dialysis or end-stage kidney disease in this country is diabetes.
And partly that's because diabetes is so prevalent, partly that's because people are living longer and the longer you live, the more chance diseases have to, uh, cause damage and long-term damage. But when people have diabetes, their sugars are often high, certainly when they're diagnosed. Uh, and we, we try to control their blood sugars, that's a mainstay of doubt of diabetes therapy. But when sugars are too high in the blood, sometimes what can happen is they can undergo a chemical reaction with proteins that are in the kidney itself. And those chemical reactions put little sugar molecules on two proteins that don't belong there. And with enough time that can cause structural damage to the kidney and, clog that filter that the kidney uses to clean blood.
And so, as the filter becomes more and more clogged, less and less blood is able to be filtered and patients start developing progressive kidney disease.
Shireen: So, what questions should one ask their doctor to see if they have kidney disease or even if they're at risk?
Staci: That's a fantastic question because kidney disease is asymptomatic and because kidney disease, because kidneys have a lot of reserve, I told you, we don't usually see symptoms until the kidney functions about 30% of normal.
And because many of the patients who develop kidney disease have a whole lot of other medical problems like diabetes or high blood pressure. And as we know, doctor visits are notoriously short. Oftentimes patients don't realize they have kidney disease because the doctor is focusing on many, many other, uh, problems that the patient has.
So, if you are at risk for kidney disease and those people are the ones with diabetes, with high blood pressure, with family history of kidney disease, if you know, that's, you, it's really important to ask your primary care doctor about your kidneys so you can ask them what's my kidney function. You can ask them to check your urine and look for protein in the urine, which is a sign of kidney damage.
And if those things are present, then we can begin taking steps, to try to slow that progression. And sometimes that looks like better controlling the diseases that are causing problems. So, we can try to make sure your blood pressure is at goal, which recommendations differ. But generally, uh, the, the current recommendation is less than 130 over 80.
So, we'll try to control your blood pressure. We try to control your diabetes. So, there's many, many reasons to control your blood sugar, but this is one of them to, uh, prevent progression of kidney disease. And so, we'll work hard with patients about correcting their blood sugar. More, there's also some medications we can, we can start the patients on that that will slow kidney disease.
Uh, and what's really exciting is in the last two years, two medications have come out that have shown an extraordinary promise, uh, in preventing the progression or slowing the progression of kidney disease.
Shireen: And so, help us understand a little bit more about these new medications and what promises are they bringing in this space?
Staci: Sure. So, these new medications are out there's, there's two different classes of medication. The first that came out and had a lot of hype in the last one to two years is something called the SGLT two inhibitors. And this is a class, these are the drugs that end in flows in. So sometimes you'll hear nephrologists calling them SGLT Two inhibitors sometimes flows in. The, uh, official names are substantially longer and more difficult to say. Um, but with these drugs have a very interesting story. They were originally designed as diabetes drugs, they lower blood sugar, um, and they work in the kidney to do so. And what we found out was they weren't doing the best job of lowering blood sugar, but patients in the trials who are taking these drugs have decreased progression of their kidney disease.
And then. People got very excited about this and started to say, well, what about giving this drug to a patient who doesn't have diabetes? Would it work in them? And we're seeing that, yes, these drugs are slowing the progression of kidney disease, even in patients without diabetes and the different drugs have been in different trials.
And so, they all have slightly different indications. So, it's important to talk to your doctor about which one might be right for you, but it’s incredibly promising and an exciting time because we haven't had a great drug to slow progression of kidney disease in about 20 years. Um, and now these new drugs are coming out.
Uh, and that's very, very exciting for patients, but what's super important is because they're so new, many doctors don't know that than yet, or aren't using them yet. So early referral to a nephrologist becomes even more important because they may be the ones who are aware of these drugs and can start using them and seeing their effects.
Shireen: You know, uh, Dr. Leisman, you mentioned in this, uh, in the previous question, you mentioned about getting that screening done, getting the blood work done to just be on top of those numbers. Um, is this screening that doctors are doing by default? If they know you have diabetes, uh, what does the awareness for that, like out there? What should a patient talk to their doctor about?
Staci: That’s a great question.
For the most part, the screening test we do in the blood is something that every patient diabetic or not, has done at least yearly at a, uh, at a doctor's appointment. So, it's just the basic chemistry. And so, when we draw basic chemistry on a patient, we measure electrolytes.
And one of the other substances that we measure is something called creatinine. And so that number that creatinine can tell us a lot about the function of the kidney. So, you can ask about that number. You can ask your doctor to look at that number and see if it's going up. And if it's going up over time, that's a sign that your kidney function is getting worse.
The urine test I would think is being done, but maybe not. I think all diabetics are supposed to have a urine screen every year. Um, and one of the things we can look for is protein and blood in the urine.
Shireen: Thank you for going through that with us. Um, so now I want to switch gears from therapeutics that we were talking about to the nutrition. Does nutrition intersect with chronic kidney disease? And if so, can you tell us how?
Staci: Sure thing, so nutrition intersects with chronic kidney disease in a bunch of different ways.
Um, one way has to do with progression. Now, the studies here are all observational, meaning they look and see a whole group of people and they compare their diets, and they compare their health outcomes.
And so those studies can give us clues as to potential causes, but they can't really prove anything because it's possible that a person who eats a particular diet also does other things and it might be that. Uh, and so they sometimes are confounding and there's never been what we call an interventional trial.
Meaning I have two patients with diabetes, and I feed them different diets and see what happens, but what we have seen and what it looks like is people who have a primarily plant-based diet. And this doesn't mean vegetarian. This doesn't mean vegan. The way that they define a plant-based diet here is a diet that is enriched in fruits, vegetables, and whole grains.
So, so what that means is that if you sometimes have chicken, that's going to be, but have the rest of that diet. You're counting as a plant-based diet. And if you're a vegan who only eats Oreos and rice, you're not counted in there because you're not eating enough fruits and vegetables. But if we look at the diets that sometimes are called the dash diet or the Mediterranean diet that are high in nuts and whole grains and fruits and vegetables, it looks like that can prevent the onset of chronic kidney disease for patients who don't have it. And it looks like it may prevent the progression of chronic kidney disease in people who have started getting chronic kidney disease. And we do know that a plant-based diet tends to have less acid load. And one of the challenges with kidney disease is the kidneys, excrete, the acid in the blood.
So, a plant-based diet gives you less acid than a heavy meat-based diet. And that also may portend better outcomes in patients with chronic kidney disease. So, I think we can't say for sure, but the evidence is suggestive that increasing the, um, whole grains, fruits, vegetables, fiber are all very beneficial in patients with chronic kidney disease.
And we do have good data that it does things like lower your blood pressure, right. Which we already talked about is important in kidney disease. So, I think, um, for a variety of reasons, that's a great idea understanding though that for some patients that can be a challenge, it's a more expensive diet and it requires a lot more effort than going to McDonald's and getting a burger.
Um, the other big place and challenge patients with chronic kidney disease have. Is I had mentioned earlier that the kidneys are responsible for, uh, eliminating toxins and eliminating certain good substances you eat that you just need to get rid of. And the two big ones that we run into challenges in our chronic kidney disease, these patients are potassium and phosphorus.
So, potassium and phosphorus are found in quite a lot of foods. Phosphorus tends to be in things like dairy, chocolate, meat, um, and potassium, and potassium is in a lot of the foods we traditionally consider as healthy foods, leafy greens, citrus fruit, uh, potatoes. And as your kidney function declines, it can become harder and harder to, uh, eliminate potassium and phosphorus.
And so sometimes patients are advised to go on a low potassium or low phosphorus diet to help with that.
Shireen: And so, and I think you answered part of this question. So, do you have specific diet suggestions that you provide as you're seeing patients? Um, even, even those without kidney disease, um, who just want to avoid, or even delay a potential kidney failure?
Staci: That's a great question. So, if your kidney function is normal and if your kidney function is even a little bit lower, but not toward the later stages, um, we actually would advise you to have a high potassium diet. And the reason is we have good studies that show the higher the potassium you eat, especially a higher potassium, lower sodium diet, it prevents heart disease, it is associated with lower blood pressure. So, I that's partly because the potassium, potassium is enriched in foods that we consider, you know, fruits and vegetables and whole grains. Um, so a high potassium diet is good initially. But to, as we go toward later stage kidney disease, then patients are advised to go on low potassium diets.
And there are handouts that you can find online, uh, that, you know, if you Google high potassium diet, if you Google kidney diet, um, you can find those. Those tips and tricks. Um, and then we can go a step further. So, something like a potato, a potato has a white potato has so much potassium. It's one of the highest potassium foods you can eat, and it can be challenging for patients to give up potatoes, but there are certain preparatory methods you can use. You boil it many, many times you discard the water, uh, and that can lower the potassium content. So sometimes it's not just about the food, but how it's prepared.
Shireen: And so, is there a go-to diet or a go-to that you provide to them in that, in that consultation?
Staci: So, it's interesting, you know, I work here in New York City. I work in East Harlem.
We have, we see a lot of patients from, uh, the Latin American, Central American community. We see a lot of patients. Um, we have a lot of, uh, immigrants from Africa here. And so, so, so traditional diets in different cultures are different, right? That’s what makes culture so beautiful and rich is, is they have a different set of cuisines.
And so, one of the challenges we do face is that many of these sheets, that list foods that are high in potassium can neglect to mention uh, foods that are staples in other cultures. So, I've run into situations with patients where their potassium is high, and we can't figure out why. And they say, well, doc, I, I don't eat anything on this list. I don't eat bananas. I don't eat potatoes. But then if you say to them, we'll do eat plantains. They say, well, I plantains all the time. We'll play a tape. Isn't on the list. Right. But bananas is. So, so for certain foods, it really becomes important. Until until the, um, community I think becomes more culturally sensitive and starts to think about what foods people are eating in their own life and their own communities.
The best thing you can do, I guess, is to give patients like a limit, you know, a three gram or two grams sodium diet, or three grand potassium diet, and then have them Google individual foods and see. Uh, how that fits in, in their diet.
Shireen: Makes sense. Well, with that Dr. Leisman, we are toward the end of the episode, um, at this point, can you tell our listeners how they can connect with you and then just learn more about your work?
Staci: Sure thing.
So, um, probably the easiest way to connect with me is on Twitter. I'm on Twitter. My handle is Staci Leisman, my first and last name together, pretty easy. Uh, I work here at, uh, the Icahn School of Medicine at Mount Sinai in New York City. But it's a big institution and a little hard to track a particular doctor down, but nephrology, there's fabulous nephrologists in every community, uh, throughout the U.S. and I think if you are at risk for kidney disease, if you're concerned, you may have kidney disease, making an appointment with a nephrologist is a great idea to discuss your risks, to discuss where you are, and to think about ways and learn ways you can decrease your risk and decrease the progression of kidney disease. If you do have it.
Shireen: Perfect. With that Dr. Leisman, thank you so much for your time here on the podcast.
Staci: Thank you for having me!
Shireen: Absolutely. And to our listeners, um, head over to our social media. After this episode, we'll keep the conversation going there and let us know what plant-based foods will you start incorporating more into your diet. Now keep in mind again, Oreos and rice does not count. Dr. Leisman mentioned that to us. So, what plant-based foods will you start incorporating in your diet? Head over to our Facebook or Instagram, let us know there. And with that Dr. Leisman thank you one more time. I appreciate it.
Staci: Thank you so much for having me Shireen. It's been a pleasure.
Shireen: Thank you for listening to the Yumlish podcast.
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