Can Nutrition Reverse Kidney Disease?

Welcome to Your Life Reset, a Verta Health podcast where bold stories meet breakthrough ideas. From massive weight loss wins to exploring the latest research, discover what's possible when science meets real life. Hey there listeners, it's Teresa Link and this is your life reset. Today's guest is Dr. Thomas Wimes, a professor at UC Santa Barbara and leading expert in kidney disease and metabolic health. His research focuses on how nutrition can help repair kidney damage and improve overall metabolic health. Last month, new research led by Verda's own Dr. Shaman Athena Orionan showed that a carbohydrate-restricted approach can not only halt the progression of chronic kidney disease in stage three, but actually reverse it. Dr. Wimes joins us to talk about what this means for patients with chronic kidney disease and the future of kidney care. Well, Dr. WMS, it's such a pleasure to have you here. Thank you so much for joining me on your life reset. — I'm great to be here, Teresa. Thanks for having me. — Now, before we get into some of the research and one of a recent study that was just published, um, can you tell us a little bit about your background, you know, what led you to study kidney disease and metabolic health? — Sure. Yeah. Uh [clears throat] I'm a professor um at the University of California in Santa Barbara. So I've been here for like 20 years or so. Um before that I was actually at the Cleveland Clinic. That was my first faculty position and that's actually where we started to work on polycystic kidney disease and uh you know I brought my lab over to you know come back to um to California and we continued the work here. Yeah. So um we we've been working on policy kidney disease for like 25 yearsish or so and you know sort of like very globally interested in kidney disease um diseases and mechanisms. Um so I run a busy uh research lab um here at the university. Um we're doing a lot of mechanistic studies but always with an eye on trying to find um you know therapeutic approaches and uh I'm also I wear a second hat um also the um the president and chief scientific officer of a company um that we launched out of the university. It's called Santa Barbara Nutrients. And in that company, we're essentially translating um those, you know, basic research findings into clinical practice. So, we have a um what's called a medical food um that's already um available and we have a nutritional intervention program that's actually a little bit similar in in its idea as a ba program uh but specifically meant for kidney disease. — Very exciting to hear about that. Very exciting. Uh thank you so much for telling us about your background. Um now for listeners who maybe are not um familiar you had mentioned a lot of work with polycystic kidney disease today specifically talking more um about chronic kidney disease and um you know the power of nutritional intervention there. So what exactly is chronic kidney disease? — Yeah, good question. Um so most so in layman's term people just usually say kidney disease you know and it usually means chronic kidney disease. So it's a — you know a slowly progressing um form of essentially losing kidney function over time uh which obviously that's not a good thing. If somebody loses actually lost their kidney function they will have to be on dialysis um for the rest of their life um or hope to get a kidney transplant. And unfortunately chronic kidney disease is um very common uh in the US. Um it affects um about 14% of the population. So it's a huge number. It's actually more common uh than cancer, more common than cardiovascular disease, you know, like stroke and heart attack. Uh more common than type two diabetes even. So um kidney disease is actually the number one uh non-communicable disease um out there. Um and many people um with chronic kidney disease don't actually know that they have it. It's um so it's you know known as a silent disease you know initially does not really cause any noticeable symptoms. So someone with chronic kidney disease wouldn't know uh that they have it often times until you know very late in the game you until their kidneys are about to fail and um sometimes they just get diagnosed essentially in the emergency room you know if they and that's where it gets caught and then of course it's essentially too late to do anything about it. Um so um that's very important is um early intervention. You mentioned that some of the symptoms you might have, you may not even notice those until it's very progressed. What might some of

those symptoms be? — Yeah. So, um so it's actually fairly easy to diagnose chronic kidney disease um based on labs, right? If somebody routinely goes to their doctor and has their labs taken, it's actually part of the standard labs is um what what's called um the creatinin value. um it's one of the markers of kidney function and it often gets converted to a value called the estimated glomeular filtration rate or the EGFR and they will tell the doctor hey you know you're at 60% kidney function um we have to do something about it but if somebody never goes to the doctor never has their labs um taken you would miss that right you wouldn't see it and you know um the kidneys even if they function at let's say 30% % function good enough um that there essentially are no symptoms. Um but if it goes you know below that um then that's when symptoms kick in. Often times it's just um high blood pressure you know um so a patient might have chronic hypertension. Um but often times you know if they don't go to the doctor don't have it addressed they also wouldn't know about it. And you know it does happen that somebody goes all the way to kidney failure and that's when all hell breaks loose and it's like numerous symptoms you know people start fainting they're losing all the energy they have pain you know there's a characteristic itch on the skin for example that um can be um you know very strong. Uh so those are some of the symptoms and sometimes somebody just ends up in the emergency room has no idea what they have uh and then they're diagnosed. — Interesting. Yeah. I think if you ask the average person, they might think, well, my kidneys would hurt or maybe kidney stones. — Yeah. — Right. Yeah. It's not that the kidneys hurt, right? Exactly. that would almost be a good thing you know if they start hurting so that somebody actually gets you know an early diagnosis um but um that doesn't happen yeah so it's these are all very non-specific symptoms that could happen due to a thousand other reasons so you wouldn't necessarily guess you know oh I must have kidney disease let me do something about it — you know what are some of the most common um other diseases that could potentially lead to chronic kidney disease that we tend to find. — Yeah, great question. So, chronic kidney disease is um the vast majority of cases are really caused by poor metabolic health and that's something that you know all about. Um so that usually means you know if somebody is you know going towards type 2 diabetes or already has type two diabetes um that is the greatest risk factor um for chronic kidney disease and that has to do with you know the essentially the blood sugar being detrimental to the kidneys you know to the little blood vessels in there but also the high blood pressure can impact the kidneys and you know there's many other mechanism that all negatively impact the kidneys and hurt the kidneys. Um that includes things like uric acid. Um that's one of the waste products that the kidneys have to clear. That's something we have been studying in my lab. So there are many mechanisms um that lead to chronic kidney disease, but they essentially are all caused uh by poor metabolic health which in turn of course is caused by nutrition and lifestyle. you know, our western, you know, standard American diet essentially really predisposes people to not only get type 2 diabetes but then also chronic kidney disease. — Gotcha. So this is not something that just pops up. This is something that has been brewing for some time, right? With other factors in poor metabolic health. You know, so many folks with type 2 diabetes have been told by their medical provider, you know, we need to make sure we're protecting your kidneys as well. I'm not sure that everyone really knows why that is, right? Um, but the damage from the high blood sugar — and also you mentioned the damage from the high blood pressure, all of that symptomatic of metabolic disease, all really playing a big role into to the damage of the kidneys over time is what I'm hearing from you. — Yeah. Yeah, for sure. And you know, diabetes um has many so somebody if [clears throat] someone has type two diabetes, they don't die of the diabetes, right? So they will have other complications that cause all these uh terrible effects you know and I'm pretty sure everyone with diabetes has it at the forefront of their mind that you know they might lose a foot for example right so the amputations and that's also caused due to um blood vessel damage you know by the high blood sugar or um blindness is very common uh in people with diabetes and um and those

are very visible things so to speak, right? So if somebody loses a foot due to the diabetes, you know, everyone knows about it, but most patients kind of overlook the kidneys, right? So even though that is actually the most common complication uh and the most common essentially life-threatening complication of type two diabetes. So I would urge everyone to pay a little bit uh of attention to their kidneys and their kidney function and have that well monitored all the time and actually do something about it. And as you mentioned this all being a symptom of poor metabolic health and what we do know there's a lot can be that can be done with lifestyle to address metabolic disease at you know at the root. Tell us about this recent study. Um you know it looked at more than 1500 people with chronic kidney disease following a carbohydrate restricted um approach. And then what I had learned was one of the most striking findings was that kidney function didn't just stabilize but it actually improved. So help us understand what that means for patients with uh kidney disease. — Mhm. Yeah. Absolutely. So this I think is a really important study and I cannot take any credit for it. All the work was actually done by your people you know at Vera Health. Um and um so the idea is you know at Vera of course you're focusing on reversing type 2 diabetes right so essentially all of the clients that go for the Verta program they have um type two diabetes they go for the program it's an intensive nutritional program um focused on uh lowering carbohydrate intake right so the sugars and the starches um and you know that's what happens in our standard American diet you with the very high carbohydrate intake. That's what's causing all the damage leading to type 2 diabetes, chronic kidney disease, and so on. And um [clears throat] most doctors um out there are actually of the opinion that um diabetes is irreversible, right? So they're thinking it's just a relentlessly progressive disease. Maybe you can slow it down a little bit, but you can never stop it, let alone, you know, reverse it, which obviously is completely incorrect. um uh you can reverse it um not really you cannot do it with um pharmarmacco therapy. So there's not a pill you can give anyone and say now your diabetes is reversed. You can do it by um taking away the initial problem the root cause of the problem you know and which is the nutrition and lifestyle and that can be done by carbohydrate restriction ketogenic nutritional intervention essentially. So that's very important that Verda can do it. Uh and you're spreading the word and you're doing studies. Um and but as a side effect um it turned out you know of course many patients with type 2 diabetes that have gone for the Verta program many of those patients already had chronic kidney disease right just as a natural byproduct of having diabetes. So the question was um how did those patients do and again if you ask the average doctor um uh especially the kidney doctors right um should I put a patient with kidney disease on a ketogenic diet I would say nine out of 10 would say they would run away and they would say no way you're going to kill all these kidneys um — which is not founded in science or any studies you know it's just somehow the assumption I don't honestly know where it really comes from. Um so now the big question came all right so Vera has treated so many folks with diabetes including folks that happen to have chronic kidney disease you know in their program if we listen to nine out of 10 kidney doctors you know all those people's kidneys should have failed much faster right so that was kind of the task at hand take a look at those um people and um this was um a work done primarily by shaminy Um Shamin is amazing. Uh she's a biostistician. She really knows how to crunch numbers, large data sets. Uh and she essentially filtered out all the patients that have gone through the um Verta program and had stage three chronic kidney disease. So stage three is kind of middle of the road chronic kidney disease. So there's already very significant functional impairment of the kidneys, but we're not yet talking endstage kidney disease. So those folks are still you know some time away from actually kidney failure. Um but there's already significant um deterioration of kidney function. Um so Shiny [clears throat] looked at all of these patients um and um looked at their kidney outcomes you know as they were going through the

Verta program um with a two-year follow-up. So we have two years worth of data for very large patient set and as you mentioned it's over 1,500 patients both chronic kidney disease stage three and um so the big question now is you know do they all rapidly lose their kidney function or does something else happen and of course the answer is you know not surprising to me but probably surprising to most kidney doctors is um that the patients did better in the two-year follow-up. um not only um do we slow the progression of um chronic kidney disease or stabilize it, we actually see an increase in kidney function. Um so essentially reversal of chronic kidney disease um and that is something that is unheard of with just um medication and uh so most kidney doctors you know they're used to prescribing drugs to their patients and they know that it's essentially not working in the sense of you know they only can achieve a slowing of the progression. Uh but reversing chronic kidney disease is not typically in the cards. Um and here we have it and as a side effect almost but unintentionally um the Verta program actually reverses chronic kidney disease. Uh and it's not a small study you know it's 1500 patients and it's not a short-term study. We're talking about two years two-year follow-up. So this is probably the largest study of this kind um ever done which to me is that's amazing that I was able to be part of it and helped out just a little bit. Um and in addition to um reversing kidney function you know which is measured by this um parameter that I mentioned earlier the eGFR the estimated glario filtration rate. In addition to improving that um the study also looked at um what's called albuminura or proteinura you can call it you know where essentially um protein uh from the blood leaks into the urine and that's can be easily measured and that's also a standard measure where people can get diagnosed of kidney function. So in those patients um with um albiminura at the beginning of the um intervention there was a statistically significant decrease in albiminura meaning improvement over time that also persisted throughout the two years. Um so again an amazing outcome. Albuminura usually indicates um a certain degree of um kidney damage and that's again due to the high blood um sugar damaging the micro vessels in the kidney. Kidney function improves the kidney damage gets better. Um that's um the best case scenario. So we we're looking at improvements on both of those fronts. Yeah. So that was um you know to me not surprising because you know we have seen the same in animal studies we see the same in polycystic kidney disease um but it's it is great to see this in such a large study um and we have such a huge data set long-term follow-up. — Absolutely. And as you've mentioned, it's so common that you said potentially nine out of 10, you know, kidney doctors might say, "Oh, never ever go on a ketogenic diet if you've got kidney disease or even anything remotely similar to that. " And as a dietitian, I also was taught that, right? You know, oh no, that is the opposite of what you need. and said, you know, that's too much protein, too much salt. You should be eating, you know, you should really be going lower on your protein. You know, even when I worked in the hospital, we would put our patients with chronic kidney disease um on low protein diets, you know, drastically reduce their salt, give them a handout of everything that they could no longer eat, right? It was just and it was contrary to many other diets that they felt like they were, you know, supposed to be following when really this is all coming down to uh metabolic disease that we can get to at the root. You know, as you mentioned, there are a lot of people out there that really still do believe that um you know, you healthy eating for kidneys is low protein, low salt. So how would you say that these findings really challenge that traditional advice? — Yeah. So as you said, you know, so there are only three macronutrients, right? So there's protein, there's carbohydrates, there's fat, and it's kind of a triangle, but if you restrict one, you kind of have to bump up, you know, one or the other, otherwise the person doesn't get any calories into them. And traditionally for kidney patients um protein has been restricted right so they're being told oh limit

your protein intake and of course everybody every doctor wants to limit fat intake you know because they're thinking it increases cardiovascular risk. So what's left over is the carbs the carbohydrates. So that means if you restrict someone's protein and someone's fat, that means your carbohydrate intake has to go through the roof and it gets higher and higher and um I think that is completely backwards especially for someone with kidney disease. Um because what is actually damaging to the kidneys is not the protein, it's not the fat, it is the carbohydrates, right? So that the old-fashioned um DOMA type of kidney diet um actually worsens if anything worsens kidney disease. So it's been always puzzling to me because you know it there's nothing unknown about it but we all know what's causing chronic kidney disease. Um the therapy out there um with regard to nutritional advice is just completely backwards, right? So it actually worsens things. Um I don't know how it has gotten like that. um uh how that's even possible. Um but I think as you know in the nephrology space um we have been restricting the wrong macronutrient right instead of restricting protein we should really be restricting the carbs the carbohydrates. So hopefully this study will provide to a little bit of clarity. I doubt it will um uh because you know patient the um there will always be a lot of criticism um you know this is um sort of a retrospective analysis. So what doctors like to see is a prospective you know placeboc controlled type of um clinical trial that's done to drug standards um without them realizing that — which we know is very difficult to do — with nutrition. Right. — Exactly. Right. Otherwise, we would do it all the time. — Exactly. Right. And you know, people don't remember that there is not a placebo for food, right? So, they think, oh, you got to have this placebo control, but what is the placebo for food, right? You can't you cannot blind people to the what they're eating where everybody knows what they're putting in their mouth and what they're cooking at home. Um, so you can never do a like an FDA um phase three type of trial with um nutritional intervention. just physically impossible. Yeah. So that's why unfortunately it will take time I think to convince everyone. — Yeah. — Um that this is the way to go. But you know I think the outcomes speak for themselves. Um and you know there's actually another study we're working on um with our friends at Verda a much larger one even with much larger um patients uh outpatient outcomes. So that should blow everything else out of the water that has ever been published before. Um and I think the outcomes are just like what we see in this study which is already a large study. — So exciting. So it sounds like there's a lot of um excitement for the future in this particular area. So what gives you the most excitement, the most hope about the future of nutritional therapy for kidney disease? — Well, I you know I'm completely convinced that it's working. you know a carbohydrate restriction restricted approach is really the way to go. Um we have seen it and we see it um also for polycystic kidney disease you know which is a genetic form of chronic kidney disease um same result you know we've already published um clinical studies many preclinical studies as well you know uh and we always see the same result but as soon as you restrict the carbohydrates um especially if you um do it on a very low carbohydrate diet in a ketogenic diet where the whole body metabolism switches is over to using ketones instead of uh instead of blood glucose. Uh that's when you get the most profound effects. I know it's working. I know it's very effective. It's, you know, just a matter of um and I think it will have a huge impact. You know, if you think of chronic kidney disease affecting 14% of the US population, we're talking, you know, 40 million people or something like that. But in the US alone and, you know, hundreds of millions worldwide. So the impact we can make uh is just gigantic and um that's where I'm very optimistic for the future that um it will be clear to everyone eventually that this is the path forward. Um it's also very accessible, right? So you don't need expensive medications that may not be even available in many parts of the world. Um anyone can change their diet, right? So that you can be poor, you can be rich. Um you can live in any country in the world, you know, you can always restrict your carbohydrates, right? So there's nobody is forcing you to eat the pasta and the pizza dough and the bread and the

grains and the fruit and so on. Um so it's up to it's in everyone's power um to restrict those and get rid of them out of their diet. That is such a wonderful message of hope uh and hope that I have for my profession um in nutrition and dietetics, clinical dietetics uh that I used to work in um a while back. Well, they would be able to walk into a patient's room in a hospital and rather than having five different sheets about what you should and should not be eating that all contradict each other, you know, one's for heart disease, one is for blood pressure, one's for diabetes, one is for IBS, one is for kidney disease, right? They're all the same. They're all we're focusing on the one type of nutritional approach that's going to help all of these things because they're all falling under metabolic disease. Maybe not IBS. I but um that's a different conversation. That's a different podcast. Uh so that gives me a lot of hope. A lot of hope too. Um so we'll close things out with some rapidfire questions from you Dr. Wime. So don't think too hard about it. just whatever comes straight to your head, I want to hear from you. Um, what is one myth about kidney disease that drives you nuts? You just wish it would go away for good. — I think this was a protein myth that we've already talked about, you know, that is just on everyone's mind. Hey, you have kidney disease, let's restrict your protein, right? And then all — right, — bad things happen here. people get their muscles waste away and um actually life expectancy goes down um if that happens. So um I think a lot of damage is done — uh and so it's a harmful one as well. Drives you nuts, but it's also very harmful um and you know the hope that over time the uh the tides will change a little bit with this. Now if you weren't studying kidneys, what area of science would you be diving into? — Yeah. Well, I must say so we only stumbled on the whole metabolic health angle in kidney disease in the last you know 5 to 10 years more five than 10 actually. Um but I really think um you know the more I've learned about it the more I think that is where the action is right now. That's where um the most impact can be done. So I would, you know, even in hindsight, you know, if I could talk to myself 20 years ago, I would have said, "Hey, Thomas, look at him at metabolic health and look at what a ketogenic diet is and that kind of thing. " Um, we could have had, you know, a lot of headway already. Uh, if I had known about all of this much earlier. Um, so yeah, that's exciting. It doesn't have to be kidneys. Um, because the same approach essentially is beneficial for essentially all of the chronic diseases out there. And um that means um you know about 90 plus% of the um the health care expenditure in the US is due to chronic diseases. Um if we can cut that down um we'll all be much better off. — Last question for you Dr. Wimes. Um what is one simple thing that everyone could do starting today to help improve their kidney health? — So I would say can I say two simple things because they're actually simple. One is um increase hydration. So drink more water and um that has to do with any number of reasons um that we're also studying in the lab where you essentially dilute the urine uh continuously and that um that is can be very protective to the kidneys. Number two, stop drinking sugary sodas um which is essentially the same thing, right? So you want to drink more fluid, but it shouldn't be sodas. It should be water or something that just doesn't contain any sugar. So that is a simple thing to just switch over. And it, you know, it's more of a habit thing. You know, especially in America, people are so used to, you know, popping a can of soda every hour. Um, and you know, before you know it, you have hundreds and hundreds of grams of sugar um in your body that you didn't need. um that the body doesn't need that are just essentially empty calories that have absolutely no benefit um but that can be very detrimental to metabolic health and kidney disease. — Very good place that most people can start one change sugary be sugary beverages especially as you said sugary sodas um a great place that people can really address something that um is really that lowhanging fruit. So Dr. Wimes it was such a pleasure to have you on. I've been looking forward to getting to chat with you for a very long time. So, thank you again so much for being here. I also really look forward to seeing uh what additional work that you do in metabolic health, not just

with kidneys uh but in this whole area. So, um I can't wait to see what's to come. — Super. Thank you, Teresa. Great questions. Thank you for that. — If you enjoyed this episode, be sure to subscribe and leave us a review on Apple or Spotify. And if you'd like to regain control of your metabolic health and feel like yourself again, check us out at verda. com. That's vir. com. Your life reset is forformational purposes only and shouldn't be considered a substitute for professional medical advice, diagnosis, or treatment. Contact your provider if you suspect you have a medical problem. I'll chat with you all again soon. Until then, stay inspired, my friends. — We're