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Autosomal Dominant Polycystic Kidney Disease (ADPKD) is the most common inherited cause of end-stage kidney disease and affects 500,000 Americans. It is characterized by fluid-filled cysts in both kidneys and gradual deterioration of kidney function. By age 70, affected folks constitute as much as 10% of the end-stage kidney disease population.
Autosomal Recessive Polycystic Kidney Disease is much less common but is more severe.
Trust me, you want to maintain normal kidney function if possible. In ADPKD, standard interventions include adequate fluid consumption, dietary sodium restriction, and keeping blood pressure below 120-125/80 mmHg.
A 2024 article in Nutrients suggests other potentially helpful dietary interventions: carbohydrate restriction and ketogenic diets. Also, avoid kidney stone formation.
Understanding chronic kidney disease (CKD) through the lens of evolutionary biology highlights the mismatch between our Paleolithic-optimized genes and modern diets, which led to the dramatically increased prevalence of CKD in modern societies. In particular, the Standard American Diet (SAD), high in carbohydrates and ultra-processed foods, causes conditions like type 2 diabetes (T2D), chronic inflammation, and hypertension, leading to CKD. Autosomal dominant polycystic kidney disease (ADPKD), a genetic form of CKD, is characterized by progressive renal cystogenesis that leads to renal failure. This review challenges the fatalistic view of ADPKD as solely a genetic disease. We argue that, just like non-genetic CKD, modern dietary practices, lifestyle, and environmental exposures initiate and accelerate ADPKD progression. Evidence shows that carbohydrate overconsumption, hyperglycemia, and insulin resistance significantly impact renal health. Additionally, factors like dehydration, electrolyte imbalances, nephrotoxin exposure, gastrointestinal dysbiosis, and renal microcrystal formation exacerbate ADPKD. Conversely, carbohydrate restriction, ketogenic metabolic therapy (KMT), and antagonizing the lithogenic risk show promise in slowing ADPKD progression. Addressing disease triggers through dietary modifications and lifestyle changes offers a conservative, non-pharmacological strategy for disease modification in ADPKD. This comprehensive review underscores the urgency of integrating diet and lifestyle factors into the clinical management of ADPKD to mitigate disease progression, improve patient outcomes, and offer therapeutic choices that can be implemented worldwide at low or no cost to healthcare payers and patients.
Steve Parker, M.D.
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Filed under kidney disease
William M. Briggs thinks that “true insurance” is the better idea. He starts with this explanation:
Health Insurance should be, but isn’t, a bet you make that you hope you lose.
It has become instead an inefficient form of socialized medicine, increasing costs. Here’s how.
Here’s what insurance should be. You bet with an Insurer that you get cancer, say. If you get it, the Insurer pays costs of care X. If you lose and remain cancer free, you pay Y. You re-bet every month (or whatever). You pay Y every time you lose. The X and Y are negotiated between you and the Insurer, and the risk of cancer is decided by you and separately by the Insurer. That is the bare bones of true Insurance. Or, indeed, of any bet.
You can also group diseases, say cancer and CHF. Then you pay Y_1 + Y_2 (say) and the costs are X_1 + X_2. The result is a contract bet just the same. But with higher stakes for both.
Suppose you already have cancer and bet the Insurer you won’t get it. You immediately win the bet! The Insurer must pay X.
How much should the Insurer charge you for this sure-thing bet? X. After all, your “pre-existing condition” is a sure-thing bet the Insurer is bound to lose. There is no sense in you making the bet.
Unless a Ruler steps in and says “Insurer, you must take this bet!” Which, of course, happens. Then the Insurer must spread the costs of X to others.
If the Insurer doesn’t spread the costs, he has sure loss (assuming calibrate bets, about which more later). Which means if you bet you have cancer when you do, when your neighbor makes a bet for cancer when he doesn’t have it, he must pay Y+S, where S represents the spread. The more people in the system, the smaller S is.
Voilà! With coverage mandates Insurance automatically becomes socialized medicine. Very inefficient, too, because not only are we paying a private entity to manage this, and take his profits, we pay bureaucrats to monitor it all. Costs must increase. Health care won’t get better, but costs must rise.
It’s worse than all this, too!
RTWT. I discuss the pros and cons of the “true insurance” idea in my book below. Dramatic price reductions done today.
Steve Parker, M.D.
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Filed under healthcare reform
I’d be much appreciative of some Amazon reviews of my 2024 book, Resuscitating U.S. Healthcare: An Insider’s Manifesto for Reform.
To make the book available to more readers, I just dramatically reduced the price at the U.S. Amazon store. $2.99 for the e-book (Kindle) or $9.95 for the paperback. I don’t know how long the prices will stay this low.
If you’re curious, at those prices Amazon pays me $2.06 for each e-book sold, and $2.74 for the paperback.
I don’t care if you leave a favorable or bad review at Amazon. Just be honest. I’ll incorporate helpful and insightful criticism into the 2nd edition.
Steve Parker, M.D.
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From the Holy Bible (NIV), Matthew 22:36-40:
36 “Teacher, which is the greatest commandment in the Law?”
37 Jesus replied: “‘Love the Lord your God with all your heart and with all your soul and with all your mind.’ 38 This is the first and greatest commandment. 39 And the second is like it: ‘Love your neighbor as yourself.’[ 40 All the Law and the Prophets hang on these two commandments.”
Or if you prefer, click for a written account of The Christmas Truce of 1914.
Filed under Uncategorized
C-reactive protein (CRP) is a bloodstream marker of body-wide inflammation. A prominent theory is that if your CRP is too high, it causes chronic disease states like hypertension, dementia, and cardiovascular disease. A 2024 meta-analysis published in British Journal of Nutrition looked at the effects of various diets on CRP. The implication is that your odds of developing particular chronic diseases is lowered if you adopt a diet that lowers your CRP. Check the Abstract below to see how your diet stacks up:
Adopting a healthy dietary pattern may be an initial step in combating inflammation-related chronic diseases; however, a comprehensive synthesis evaluating current evidence is lacking. This umbrella review aimed to summarise the current evidence on the effects of dietary patterns on circulating C-reactive protein (CRP) levels in adults. We conducted an exhaustive search of the Pubmed, Scopus and Epistemonikos databases, spanning from their inception to November 2023, to identify systematic reviews and meta-analyses across all study designs. Subsequently, we employed a random-effects model to recompute the pooled mean difference. Methodological quality was assessed using the A Measurement Tool to Assess Systematic Reviews 2 (AMSTAR 2) checklist, and evidence certainty was categorised as non-significant, weak, suggestive, highly suggestive or convincing (PROSPERO: CRD42023484917). We included twenty-seven articles with thirty meta-analyses of seven dietary patterns, fifteen of which (50 %) exhibited high methodological quality. The summary effects of randomised controlled trials (RCT) found that the Mediterranean diet was the most effective in reducing circulating CRP levels, followed by Vegetarian/Vegan and Energy-restricted diets, though the evidence was of weak quality. In contrast, Intermittent Fasting, Ketogenic, Nordic and Paleolithic diets did not show an inverse correlation with circulating CRP levels. Some results from combined interventional and observational studies, as well as solely observational studies, also agreed with these findings. These dietary patterns show the potential in reducing CRP levels in adults, yet the lack of high-quality evidence suggests future studies may alter the summary estimates. Therefore, further well-conducted studies are warranted.
Steve Parker, M.D.
Filed under Longevity, Mediterranean Diet
Therapeutic exercise helps a little. But don’t expect a dramatic improvement, according to this 2023 study published at The Lancet Rheumatology. The benefits tend to accrue to patients who are in most pain and most physically impaired at baseline.
If you’re carrying a lot of excess weight, it only stands to reason that weight loss would take some stress off those worn-out joints. Let me help you.
Steve Parker, M.D.
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Many physicians and dietitians have been hesitant to suggest ketogenic diets due to 1) possible increased risk of cardiovascular disease, and 2) unknown effects on overall mortality.
But a study published at Scientific Reports in October 2024 suggests that ketogenic diets reduce overall mortality by 24% with no effect on cardiovascular-related deaths. Click the link to see the full report. I haven’t read it yet. Don’t ask me what “restricted cubic spline function” means!
Steve Parker, M.D.
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Filed under coronary heart disease, Heart Disease, ketogenic diet, Longevity, Stroke
In the video below, JP implies that it is. He’s technically correct in that it is banned in some European countries according to a January 2024 article at HealthNews. Ozempic and Wegovy are brand names for the same drug: semaglutide, a GLP-1 receptor agonist. Wegovy is FDA-approved for treatment of particular folks with obesity whereas Ozempic is FDA-approved for treatment of type 2 diabetes.
I understand the superficial appeal of drug-induced weight management: no need to fool with exercise and dietary restriction.
Steve Parker, M.D.
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Filed under Drugs for Diabetes, Weight Loss
We’ve heard or suspected for years that whole foods are healthier for us than processed and ultra-processed foods. But is it true?
The British Medical Journal earlier this year published a study concluding that:
…a higher intake of ultra-processed foods was associated with slightly higher all cause mortality, driven by causes other than cancer and cardiovascular diseases. The associations varied across subgroups of ultra-processed foods, with meat/poultry/seafood based ready-to-eat products showing particularly strong associations with mortality.
You can read the study for yourself free online. Did Big Food (e.g., Archer Daniels Midland, Con-Agra, Monsanto) exert any pressure on the researchers. I dunno.
From the Intro:
Ultra-processed foods are ready-to-eat/heat industrial formulations made mostly or entirely from substances derived from foods, including flavors, colors, texturizers, and other additives, with little if any intact whole food.1Ultra-processed foods, which are typically of low nutritional quality and high energy density, have been dominating the food supply of high income countries, and their consumption is markedly increasing in middle income countries.2 Ultra-processed food consumption accounts for 57% of daily energy intake among adults and 67% among youths in the US according to the National Health and Nutrition Examination Survey (NHANES).34
Ultra-processed foods usually disproportionately contribute added sugars, sodium, saturated fats and trans fats, and refined carbohydrates to the diet together with low fiber.56 As well as having low nutritional quality, ultra-processed foods may contain harmful substances, such as additives and contaminants formed during the processing.
Neurologist Steven Novella wrote a brief post about this study over at Science-Based Medicine. You may also find the comment section there enlightening.
Steve Parker, M.D.
Filed under Longevity
Click the pic to purchase at Amazon.com. E-book versions also available at Smashwords.com.
Bible Verse of the Day
Diabetic Mediterranean Diet 