ReportWire

Tag: kidney failure

  • Is Fasting an Effective Treatment for Diabetes? | NutritionFacts.org

    [ad_1]

    By losing 15% of their body weight, nearly 90% of those who have had type 2 diabetes for less than four years may achieve remission.

    Currently, more than half a billion adults have diabetes, and about a 50% increase is expected in another generation. I’ve got tons of videos on the best diets for diabetes, but what about no diet at all?

    More than a century ago, fasting was said to cure diabetes, quickly halting its progression and eliminating all signs of the disease within days or weeks. Even so, starvation is guaranteed to lead to the complete disappearance of you if kept up long enough. What’s the point of fasting away the pounds if they’re just going to return as soon as you restart the diet that created them in the first place? Might it be useful to kickstart a healthier diet? Let’s see what the science says.

    Type 2 diabetes has long been recognized as a disease of excess, once thought to afflict only “the idle rich…anyone whose environment and self-support does not require of him some sustained vigorous bodily exertion every day, and whose earnings or income permit him, and whose inclination tempts him, to eat regularly more than he needs.” Diabetes is preventable, so might it also be treatable? If we’re dying from overeating, maybe we can be saved by undereating. Remarkably, this idea was proposed about 2,000 years ago in an Ayurvedic text:

    “Poor diabetic people’s medicine
    He should live like a saint (Munni);
    He should walk for 800–900 miles.
    Or he shall dig a pond;
    Or he shall live only on cow dung and cow urine.”

    That reminds me of the Rollo diet for diabetes proposed in 1797, which was composed of rancid meat. That was on top of the ipecac-like drugs he used to induce severe sickness and vomiting. Anything that makes people sick has only “a temporary effect in relieving diabetes” because it reduces the amount of food eaten. His diet plan—which included congealed blood for lunch and spoiled meat for dinner—certainly had that effect.

    Similar benefits were seen in people with diabetes during the siege of Paris in the Franco‐Prussian War, leading to the advice to mangez le moins possible, which translates to “eat as little as possible.” This was formalized into the Allen starvation treatment, considered to be “the greatest advance in the treatment of diabetes prior to the discovery of insulin.” Before insulin, there was “The Allen Era.”

    Dr. Allen noted that there are clinical reports of even severe diabetes cases clearing up after the onset of a “wasting condition” like tuberculosis or cancer, so he decided to put it to the test. He found that even in the most severe type of diabetes, he could clear sugar from people’s urine within ten days. Of course, that’s the easy part; it’s harder to maintain once they start eating again. To manage patients’ diabetes, he stuck to two principles: Keep them underweight and restrict the fat in their diet. A person with severe diabetes can be symptom-free for days or weeks, but eating butter or olive oil can make the disease come raging back.

    As I’ve said before, diabetes is a disease of fat toxicity. Infuse fat into people’s veins through an IV, and, by using a high-tech type of MRI scanner, you can show in real time the buildup of fat in muscle cells within hours, accompanied by an increase in insulin resistance. The same thing happens when you put people on a high-fat diet for three days. It can even happen in just one day. Even a single meal can increase insulin resistance within six hours. Acute dietary fat intake rapidly increases insulin resistance. Why do we care? Insulin resistance in our muscles, in the context of too many calories, can lead to a buildup of liver fat, followed by fat accumulation in the pancreas, and eventually full-blown diabetes. “Type 2 diabetes can now be understood as a state of excess fat in the liver and pancreas, and remains reversible for at least 10 years in most individuals.”

    When people are put on a very low-calorie diet—700 calories a day—fat can get pulled out of their muscle cells, accompanied by a corresponding boost in insulin sensitivity, as shown below and at 4:43 in my video Fasting to Reverse Diabetes.

    The fat buildup in the liver has then been shown to decrease substantially, and if the diet is continued, the excess fat in the pancreas also reduces. If caught early enough, reversing type 2 diabetes is possible, which would mean sustained healthy blood sugar levels on a healthy diet.

    With the loss of 15% of body weight, nearly 90% of individuals who have had type 2 diabetes for less than four years can achieve non-diabetic blood sugar levels, whereas it may only be reversible in 50% of those who’ve lived with the disease for longer than eight years. That’s better than bariatric surgery, where those losing even more weight had lower remission rates of 62% and 26%, respectively. Your forks are better than surgeons’ knives. Indeed, most people who have had their type 2 diabetes diagnosis for an average of three years can reverse their disease after losing about 30 pounds, as you can see below and at 5:37 in my video.

    Of course, an extended bout of physician-supervised, water-only fasting could also get you there, but you would have to maintain that weight loss. One of the things that has been said with “certainty” is that if you regain the weight, you regain your diabetes.

    To bring it full circle, “the initial euphoria about ‘medicine’s greatest miracle’”—the discovery of insulin in 1921—“soon gave way to the realisation” that, while it was literally life-saving for people with type 1 diabetes, insulin alone wasn’t enough to prevent such complications as blindness, kidney failure, stroke, and amputations in people with type 2 diabetes. That’s why one of the most renowned pioneers in diabetes care, Elliott Joslin, “argued that self-discipline on diet and exercise, as it was in the days prior to the availability of the drug [insulin], should be central to the management of diabetes….”

    Doctor’s Note

    Check out Diabetes as a Disease of Fat Toxicity for more on the underlying cause of the disease.

    For more on fasting for disease reversal, see:

    Fasting is not the best way to lose weight. To learn more, see related posts below.

    What is the best way to lose weight? See Friday Favorites: The Best Diet for Weight Loss and Disease Prevention.

    [ad_2]

    Michael Greger M.D. FACLM

    Source link

  • Colorado man raising awareness, hope as he waits for second kidney transplant

    [ad_1]

    LITTLETON, Colo. — A Colorado man is raising awareness and hope as he waits for a second kidney transplant.

    Facing polycystic kidney disease, a genetic form of the disease, Rick Mendoza received a kidney transplant from his sister-in-law in 2011. He said it made him feel “fully alive” and allowed him to be present for his daughter’s formative years.

    “She probably didn’t want me on the sidelines as much during her soccer games, but I was there supporting her and cheering her,” he told Denver7.

    Mendoza family

    But just over a decade later, in 2022, Mendoza became sick again.

    “You feel like your energy level, you had no longer the energy to do things,” he explained. “With kidney failure, your red blood cells take away the oxygen that goes throughout your body, so you feel anemic, and then there’s nausea.”

    It turns out his donated kidney was failing “abruptly.” He went back on a transplant wait list, which can take several years on average. He also went back to dialysis treatments, which can take a toll.

    Chronic kidney disease gradually damages the kidneys, making it harder for them to filter waste or excess fluid out of the blood, leading to serious health problems.

    Rick Mendoza

    Mendoza family

    Joseph Garcia is a group regional operations director with DaVita, a Denver-based company with dialysis centers across the country. He said patients typically are treated multiple times a week, “anywhere from three and a half to four-plus hours.”

    “About half of our patients who end up on dialysis services, meaning their kidneys failed, crash into it, meaning they had no idea that their kidneys were at risk,” Garcia told Denver7.

    That underscores findings from the National Kidney Foundation that one in seven U.S. adults has chronic kidney disease, but 90 percent of them don’t realize they have it because symptoms can be mild or non-existent at first.

    Rick Mendoza and his family spread kidney disease awareness at the Denver Kidney Walk.

    Mendoza family

    Rick Mendoza and his family spread kidney disease awareness at the Denver Kidney Walk.

    Mendoza now volunteers with the National Kidney Foundation to raise awareness.

    “I think this time around, I felt that I needed to do something more than just looking out for myself,” he explained. “I think there are others that are less fortunate than me.”

    Those with high blood pressure or diabetes are especially at risk for kidney disease. Garcia and kidney health advocates encourage regular doctor visits, as well as blood or urine exams.

    “I think the biggest thing I would encourage people to do is proactive screenings, proactive conversations,” Garcia told Denver7.

    A healthy diet and exercise, they say, can also promote good kidney health, something Mendoza embodies even while going through dialysis treatments.

    “The next day [after treatment], I feel, you know, that I can do a lot of things, like golf. I work full-time,” he explained.

    Rick Mendoza

    Mendoza family

    Garcia praised Mendoza for his mindset amid the struggles.

    “He’s amazing,” Garcia said. “When you think about his journey with his kidney health and how he just has a positive attitude, he lives a fully active lifestyle, he’s an ambassador and a champion for other kidney care patients. It’s a privilege to work with him.”

    Mendoza is not waiting to live, even as he waits for another donor.

    “I’m hoping that day comes,” he said. “But until then, and after then, I just want to do more, and I feel like I do more with what I have to offer.”

    Denver7 is a proud sponsor of the Denver Kidney Walk. Anchor/reporter Ryan Fish will emcee the event on Sunday, Oct. 5, at Great Lawn Park in Denver.

    ryan image bar.jpg

    Denver7 | Your Voice: Get in touch with Ryan Fish

    Denver7’s Ryan Fish covers stories that have an impact in all of Colorado’s communities, but specializes in covering artificial intelligence, technology, aviation and space. If you’d like to get in touch with Ryan, fill out the form below to send him an email.

    [ad_2]

    Ryan Fish

    Source link

  • Can We Safely Use Melamine Dishes and Polyamide Plastic Utensils? | NutritionFacts.org

    Can We Safely Use Melamine Dishes and Polyamide Plastic Utensils? | NutritionFacts.org

    [ad_1]

    I recommend glass, ceramic, porcelain, or stainless steel tableware and wooden or stainless steel cooking utensils.

    Melamine is used to make a variety of hard plastic “food contact items such as cups, plates, bowls, and utensils because they are dishwasher safe, inexpensive, and durable.” If that word sounds familiar, it may be because melamine has also been added illegally to protein products to game the system to make it appear that “food commodities” like pet food contain more protein than they actually do. By 2007, more than a thousand potentially contaminatedpet food products were recalled after “the chemical was found to be a contaminant in wheat gluten used in those products,” but not before it caused disease and death in pets throughout North America. 

    “It is presumed that melamine was intentionally added by suppliers in China to falsely elevate the measured protein content and, hence, the monetary value of these products.” The pet food scandal was just the writing on the wall. The following year, “melamine was discovered to be the cause of an outbreak of urinary tract stones and renal failure” (kidney stones and kidney failure), affecting hundreds of thousands of infants and young children throughout China. “Investigations revealed that the compound was added illegally to powdered milk and baby formulas to falsify protein content.” 

    As I discuss in my video Are Melamine Dishes and Polyamide Plastic Utensils Safe?, in the United States, you can find it in food packaging and sneaking its way into animal feed. However, those using melamine dishware can be exposed directly, as it migrates straight into the food upon exposure to heat. In fact, “cooking spoons and crockery made of melamine resin are not suited for microwaves and cooking,” according to food safety authorities. Okay, but what if you never cook with it, fry with it, or microwave it? What if you just use melamine to eat out of? 

    In “A Crossover Study of Noodle Soup Consumption in Melamine Bowls and Total Melamine Excretion in Urine,” researchers measured the amount of melamine flowing through the study subjects’ bodies compared to eating the same soup out of ceramic bowls. Their findings? “Melamine tableware may release large amounts of melamine when used to serve high-temperature foods”—and not even hot foods. “Melamine migration can be detectable from daily-use melamine-made tableware, even in the low temperatures,” like just warm water. Why do we care? Because the level of melamine you’re exposed to “is significantly associated with kidney function deterioration in patients with early-stage CKD,” chronic kidney disease, in which even relatively “low melamine levels may cause a rapid decline in kidney function.” So, I would suggest glass, ceramic, porcelain, or stainless steel tableware instead. 

    What about polyamide utensils, common black plastic spoons, spatulas, and the like? All sorts of different plastic materials are used in kitchen utensils. Polyamide is “typically used for turners [spatulas] or ladles due to their high heat and oil resistance.” “However, components of this plastic can migrate from the utensils into the food and consequently be ingested by consumers.” Out of 33 utensils tested, nearly 1 in 3 exceeded the upper safety limit. The German Federal Institute for Risk Assessment “recommends that consumers keep contact with food as brief as possible when using PA [polyamide] kitchen gadgets, especially at high temperatures,” such as above the temperature at which we may drink hot tea or coffee. 

    A different survey of black plastic kitchen utensils found about a third contaminated with flame retardant chemicals. Why? Because it may be made from plastic recycled from electronic equipment that was impregnated with the stuff. Then, should you dip the polyamide utensil into oil, the chemicals can trickle out, suggesting that using such “utensils for frying may lead to considerable dietary exposure.”

    The black dye itself in some polyamide utensils can leach out, too. Eventually, with enough use, the levels drop, but it may take the equivalent of boiling the utensils for about a hundred hours before the dye leaking approaches safety levels. It’s probably just easier to use utensils that are wooden or stainless steel.

    This is the last in a three-part series of cookware videos. If you missed the others, check out Are Aluminum Pots, Bottles, and Foil Safe? and Stainless Steel or Cast Iron: Which Cookware Is Best? Is Teflon Safe?.

    It may not be safe to microwave melamine, but what about microwaving in general? See Are Microwaves Safe? and The Effects of Radiation Leaking from Microwave Ovens

    [ad_2]

    Michael Greger M.D. FACLM

    Source link

  • Father of girl hospitalized with E. coli after swim in Lake Anna: ‘It’s just been a whole nightmare for us’ – WTOP News

    Father of girl hospitalized with E. coli after swim in Lake Anna: ‘It’s just been a whole nightmare for us’ – WTOP News

    [ad_1]

    The father of a teenager from Warrenton, Virginia, said his daughter has been hospitalized with kidney failure after she was diagnosed with E. coli after a Memorial Day swim at Lake Anna in Spotsylvania County.

    After spending Memorial Day weekend at Lake Anna with friends, Ava Inglett (top right in left photo) was hospitalized with kidney failure.(Courtesy John Inglett)

    The father of a teenager from Warrenton, Virginia, said his daughter has been hospitalized after she was diagnosed with E. coli after a Memorial Day swim at Lake Anna in Spotsylvania County.

    John Inglett said his daughter Ava was one of 20 reported cases of the illness linked to the lake. Ava had gone to the lake with friends on Memorial Day. A day later, she started getting sick.

    “We thought it was just going to be a quick sickness kind of thing,” Inglett said. “So we let it go a little bit further than we really wanted to, but it ended up in an emergency room visit.”

    Inglett said other parents contacted him and his wife, Judy, to let them know their children also came down with a similar illness and that doctors told those parents to keep their children hydrated as it runs its course.

    “We were not alarmed until that Friday, when she started having bloody diarrhea and throwing up violently,” Inglett said.

    He said they consulted their pediatrician who said the best course of action was to keep Ava hydrated, but when she showed little improvement over time, they decided to take her to the emergency room.

    “We’re just going to take her to the ER, maybe just get her on an IV just because, based on what everybody’s telling us, she’s got an issue with being hydrated,” Inglett said. “Later in the afternoon, (they) explained our situation, said, ‘Hey, you know she needs to be on fluids. We think she has E. coli, and it’s not getting any better.”

    Doctors also took blood work, and the results showed Ava was in kidney failure.

    “I was in just disbelief,” her father added. “It’s just been a whole nightmare for us.”

    Ava was later transferred to the Inova Fairfax Medical Campus where she underwent days of dialysis and three blood transfusions.

    On Thursday, Ava’s parents said doctors were optimistic that Ava will eventually be able to come off dialysis and be released on Friday.

    Both parents believe more should have been done to test the water of Lake Anna and other Virginia lakes, and visitors should be warned about the possible danger of bacteria such as E. coli.

    “There needs to be a warning system or a way for people to get more information on, ‘Hey, when I go to this lake, not just Lake Anna but any type of lake, that this could possibly happen,’” Inglett said.

    The Virginia Department of Health said it is investigating reported cases and testing the water. On Monday, the state said water testing results could be back as soon as Thursday.

    WTOP has reached out to the Virginia Department of Health for an update.

    John and Judy are warning other parents to be aware of this risk, which can come with swimming in lakes.

    “My daughter went down there 100% healthy, and she came out of there pretty much on life support, hoping that her kidneys will recover,” her father said.

    Get breaking news and daily headlines delivered to your email inbox by signing up here.

    © 2024 WTOP. All Rights Reserved. This website is not intended for users located within the European Economic Area.

    [ad_2]

    Mike Murillo

    Source link

  • The Safety of Fasting to Lose Weight  | NutritionFacts.org

    The Safety of Fasting to Lose Weight  | NutritionFacts.org

    [ad_1]

    Why should fasts lasting longer than 24 hours and particularly for three or more days only be done under the supervision of a health professional and preferably in a live-in clinic? 
     
    Fasting for a week or two can actually interfere with the loss of body fat, as shown at the start of my video Is Fasting for Weight Loss Safe?. But, eventually, after the third week of fasting, fat loss starts to overtake the loss of lean body mass in obese individuals, as seen in the graph below and at 0:14 in my video. Is it safe to go that long without food? 

    Proponents speak of fasting as a cleansing process, but some of what is being purged from our bodies are essential vitamins and minerals. People who are heavy enough can fast up to 382 days without calories, but no one can go even a fraction of that long without vitamins. Scurvy, for example, can be diagnosed within as few as four weeks without any vitamin C. Beriberi, deficiency of thiamine (vitamin B1), may start even earlier in fasting patients. And, once it manifests, it can result in brain damage within days, which can eventually become irreversible.  
     
    Even though fasting patients report problems such as nausea and indigestion after taking supplements, all of the months-long fasting cases I’ve discussed previously were given daily multivitamins and mineral supplementation as necessary. Without supplementation, hunger strikers and those undergoing prolonged fasts for therapeutic or religious purposes (like the Baptist pastor hoping “to enhance his spiritual powers for exorcism”) have ended up paralyzed, become comatose, or worse. 
     
    Nutrient deficiencies aren’t the only risk. After reading about all of the successful reports of massive weight loss from prolonged fasting in the medical literature, one doctor decided to give it a try with his patients. Of the first dozen he tried it on, two died. In retrospect, the two patients who died had started out with heart failure and had been on diuretics. Fasting itself produces pronounced diuresis, meaning loss of water and electrolytes through the urine, so it was the combination of fasting on top of the water pills that likely depleted their potassium and triggered their fatal heart rhythms. The doctor went out of his way to point out that both of the people who died started out “in severe heart failure, complicated by gross obesity; but both had improved greatly whilst undergoing starvation therapy.” That seems like a small consolation since they were both dead within a matter of weeks. 
     
    Not all therapeutic fasting fatalities were complicated by concurrent medication use, though. One researcher writes: “At first he did very well and experienced the usual euphoria…His pulse, blood pressure, and electrolytes remained satisfactory, but in the middle of the third week of treatment, he suddenly collapsed and died. This line of treatment is certainly tempting because it does produce weight loss and the patient feels so much better, but the report of case-fatalities”—the whole part about killing people—“must make it a very suspect line of management.” 
     
    Contrary to the popular notion that the heart muscle is specially spared during fasting, the heart appears to experience similar muscle wasting. This was “described in the victims of the Warsaw ghetto” during World War II in a remarkable series of detailed studies carried out by the ghetto physicians before they themselves succumbed. In a case entitled “Gross Fragmentation of Cardiac Fiber After Therapeutic Starvation for Obesity,” a 20-year-old woman successfully “achieved her ideal weight” after losing 128 pounds by fasting for 30 weeks. “After a breakfast of one egg,” she had a heart attack and died. On autopsy, as you can see below and at 3:44 in my video, the muscle fibers in her heart showed evidence of widespread disintegration. The pathologists suggested that fasting regimens “should no longer be recommended as a safe means of weight reduction.” 
    Breaking the fast appears to be the most dangerous part. After World War II, as many as one out of five starved Japanese prisoners of war tragically died following liberation. Now known as “refeeding syndrome,” multiorgan system failure can result from resuming a regular diet too quickly. This is because there are critical nutrients such as thiamine and phosphorus that are used to metabolize food. Therefore, in the critical refeeding window, if too much food is taken before these nutrients can be replenished, demand may exceed supply. Whatever residual stores you still carry can be driven down even further, with potentially fatal consequences. This is why rescue workers are taught to always give thiamine before food to victims who have been trapped or otherwise unable to eat. Thiamine is responsible for the yellow color of “banana bags,” a term you might have heard used in medical dramas to describe an IV fluid concoction often given to malnourished alcoholics to prevent a similar reaction. (You can see a photo of them below and at 4:53 in my video.) Anyone “with negligible food intake for more than five days” may be at risk of developing refeeding problems. 
    Medically-supervised fasting has gotten much safer now that there are proper refeeding protocols. We now know what warning signs to look for and who shouldn’t be fasting in the first place, such as those who have advanced liver or kidney failure, porphyria, uncontrolled hyperthyroidism, and pregnant and breastfeeding women. The most comprehensive safety analysis of medically supervised, water-only fasting was recently published by the TrueNorth Health Center in California. Out of 768 visits to its facility for fasts up to 41 days, were there any adverse events? There were 5,961 of them! Most of these were mild, known reactions to fasting, such as fatigue, nausea, insomnia, headache, dizziness, upset stomach, and back pain. Only two serious events were reported, and no fatalities. You can see the chart below and at 5:58 in my video
    Fasting periods lasting longer than 24 hr, and particularly those lasting 3 or more days, should be done under the supervision of a physician and preferably in a [live-in] clinic.” In other words, don’t try this at home! This is not just legalistic mumbo-jumbo. For example, normally, your kidneys dive into sodium conservation mode during fasting, but should that response break down, you could rapidly develop an electrolyte abnormality that may only manifest with non-specific symptoms, like fatigue or dizziness, which could easily be dismissed until it’s too late. 
     
    The risks of any therapy must be premised on the severity of the disease. The consequences of obesity are considered so serious that effective therapies could have “considerable acceptable toxicity.” For example, many consider major surgery for obesity to be a justifiable risk, but the keyword is effective. 
     
    Therapeutic fasting for obesity has largely been abandoned by the medical community not only because of its uncertain safety profile but its questionable short- and long-term efficacy. Remember, for a fast that only lasts a week or two, you might be able to lose as much body fat or even more on a low-calorie diet than a no-calorie diet. 
     
    Fasting for a week or two can actually interfere with the loss of body fat. For more background on this, see Is Fasting Beneficial for Weight Loss? and Benefits of Fasting for Weight Loss Put to the Test.
     
    If you’re wondering what the best way to lose weight is, I wrote a whole book about it! Check out How Not to Diet
     
    Interested in learning more about fasting? See related videos below. 

    [ad_2]

    Michael Greger M.D. FACLM

    Source link

  • Major step forward reduces mortality in kidney failure patients

    Major step forward reduces mortality in kidney failure patients

    [ad_1]

    Newswise — Mortality in patients with kidney failure has been found to be 23% lower among those treated with high dose haemodiafiltration compared to those treated with high flux haemodialysis, according to new research from the CONVINCE consortium led by University Medical Center Utrecht.

    The study, published today in the New England Journal of Medicine, is the first international, randomised trial to compare the two treatments. The findings indicate that wider use of high dose haemodiafiltration would have clear benefits for patients.

    Chronic kidney disease is a leading global health problem that affects an estimated 830 million people globally. When the kidneys can no longer do their job, dialysis is used to clean the blood by removing waste products, a function normally performed by the kidneys themselves. Around four million people are on dialysis worldwide.

    Haemodialysis is the most common form of dialysis used in the treatment for kidney failure1. Though it has improved over the years, it is not good at removing larger molecules from the blood. Haemodiafiltration is a newer technology that can remove larger molecules, but it is not suitable for all patients due to the fact that it requires a higher blood flow rate to be effective. Previous studies have failed to conclusively prove that one method is more effective than the other.

    The CONVINCE trial has been led by researchers at UMC Utrecht together with collaborators at University College London (UCL), Charité Universitätsmedizin Berlin, University of Bari, The George Institute for Global Health and Imperial College London, along with dialysis providers Fresenius Medical Care, Diaverum and B. Braun Avitum. It is the first multinational, randomised trial to compare high-flux haemodialysis and high-dose haemodiafiltration, with the aim of clarifying which method is superior.

    At 61 centres in eight European countries, a total of 1,360 patients were randomised, with 683 treated with high-dose haemodiafiltration and 677 treated with high-flux haemodialysis three times a week.

    During a median follow-up of 30 months, all-cause mortality was 21.9% among those treated with high-flux haemodialysis, compared to 17.3% for those treated with high-volume haemodiafiltration. This 4.6% difference represents a 23% reduction in the risk of death.

    Lead investigator, Professor Peter Blankestijn (UMC Utrecht), said: “Our results show clear survival benefits for using haemodiafiltration over haemodialysis to treat kidney failure, akin to a 23% reduction in all-cause mortality. My hope is that haemodiafiltration can become the new standard.”

    Professor Matthias Rose (Charité University, Berlin), a senior author of the study and expert in patient-reported outcomes, said: “In addition to clinical events, patient perception and thus reported outcomes are very important.  We are currently performing in-depth analyses of the extensive data on patient-reported outcomes that have been collected in the CONVINCE study, with results expected later this year.”

    While haemodialysis is standard treatment in most countries, haemodiafiltration is less widely used in some places and is not used at all in places like the US. Most modern dialysis machines can perform either method, which would make a switch to haemodiafiltration relatively easy.

    Professor Andrew Davenport (UCL Medicine and the Royal Free Hospital), a senior author of the study, said: “During my career I’ve watched new treatments emerge for many diseases, from diabetes to cancer, but we haven’t seen the same advances in the treatment of chronic kidney disease. This study proves that targeting different molecules through haemodiafiltration has clear benefits for patients. I would say that this is the first major step forward in many years and is good news for kidney disease patients and their families.”

    The CONVINCE study was exclusively supported by the European Commission Research & Innovation, Horizon 2020, Call H2020-SC1-2016-2017 under the topic SC1-PM-10-2017: Comparing the effectiveness of existing healthcare interventions in the adult population (grant no 754803).

    [ad_2]

    University College London

    Source link

  • Ozempic Is About to Be Old News

    Ozempic Is About to Be Old News

    [ad_1]

    All of a sudden, Ozempic is everywhere. The weight-loss drug that it contains, semaglutide, is a potent treatment for obesity, and Hollywood and TikTok celebrities have turned it into a sensation. In just a few months, the medication has been branded as “revolutionary” and “game-changing,” with the power to permanently alter society’s conceptions of fatness and thinness. Certainly, a drug like semaglutide could be all of those things: Never in the history of medicine has one so safely led to such dramatic weight loss in so many people.

    But let’s not get ahead of ourselves. As weight-loss medications go, Ozempic is far from perfect. Though the drug has profound impacts, it requires weekly injections, a tolerance for uncomfortable side effects, and the stamina—not to mention the budget—for long-term treatment. (Ozempic has somehow become a catchall term for semaglutide but technically that product has gotten FDA sign-off only as a diabetes medication. A larger dose of semaglutide, marketed as Wegovy, has been approved for weight loss.)

    Made by the Danish drugmaker Novo Nordisk, semaglutide dominates the U.S. weight-loss market right now, but its reign might be short-lived. The colossal demand for these drugs has spurred a competition in the pharmaceutical industry to develop even more potent and powerful medications. The first of them could become available as soon as this summer. For all its hype, semaglutide is the stepping stone and not the final destination of a new class of obesity drugs. Just how good they get, and how quickly, will go a long way in determining whether this pharmaceutical revolution actually meets its full promise.

    In a sense, semaglutide hardly represents a major step forward in science. Diet drugs are nothing new, and even the category of pharmaceuticals that these new products belong to, called “GLP-1 agonists,” has been around for several years. These drugs mimic the hormone GLP-1 (glucagon-like peptide one) and bind to its receptor in the body. This triggers a sense of fullness associated with having just eaten, and also slows the release of food from the stomach. (It also increases insulin secretion, keeping blood sugar in check, which is why Ozempic is still intended as a diabetes drug.) Already, these pharmaceuticals have gotten better over time: A daily injection called liraglutide and sold as Saxenda, which was approved by the FDA in 2014 for obesity, leads to the loss of 5 to 10 percent of a person’s body weight in most cases. But one reason semaglutide took off in a way that liraglutide didn’t is that it can lead to weight loss of up to 20 percent. “Now you have a shot that’s once a week instead of every day, you’re making dramatic improvements, and people notice more,” Angela Fitch, the president of the Obesity Medicine Association and the chief medical officer of the obesity-care start-up Knownwell, told me.

    But not everyone who takes these drugs can achieve that level of weight loss. More than 60 percent of those on Wegovy experience smaller changes, in part because the drug can’t account for the complex drivers of obesity that aren’t related to food. The next generation of drugs is reaching for more. The first leap forward is Mounjaro, known generically as tirzepatide, a diabetes drug from Eli Lilly that the FDA is expected to approve for weight loss this year. In one study, it led to 20 percent or more weight loss in up to 57 percent of people who took the highest dose; The Wall Street Journal recently called it the “King Kong” of weight-loss drugs. People on Mounjaro tend to lose more weight more quickly and generally have a “better experience” than those on Wegovy, Keith Tapper, a biotech analyst at BMO Capital Markets, told me. It’s also cheaper, though by no means cheap, at roughly $980 for the highest-dose option, he said; a dose of Wegovy costs about $1,350.

    These leaps in potency are happening on the molecular level. Like semaglutide, Mounjaro mimics the effects of GLP-1, but it also hits receptors for another hormone—GIP. That leads to even more weight loss by further attenuating focus on food and potentially also increasing the activity of a fat-burning enzyme, said Tapper. So-called dual-agonist drugs “offer a step change” in both weight loss and blood-sugar control, he added.

    And why stop at two receptors when so many others are involved in regulating hunger? “This area is exploding in terms of research and testing different combinations of hormones,” which are still poorly understood, Shauna Levy, a professor specializing in bariatric surgery at Tulane University School of Medicine, told me. Eli Lilly has another drug in the works that targets three receptors; one from the drugmaker Amgen works by “putting the brakes” on the GIP receptor and “putting the gas” on GLP-1’s, a company spokesperson told me. Several other companies have already joined what some have dubbed a “race” to develop the next great obesity drug, in which Lilly, Pfizer, Amgen, Structure Therapeutics, and Viking Therapeutics are expected to be the front-runners, said Tapper.

    The potency of weight-less drugs is not the only factor that will determine the shape of their future trajectory. Wegovy and Mounjaro injections are tolerable for most people, but they are less convenient than a pill. Making oral versions of these drugs isn’t as easy as packing everything into a capsule, though. Semaglutide is a molecule that gets chewed up in the stomach. For this reason, the semaglutide pill Rybelsus, which is already approved for diabetes, leads to far less dramatic weight loss than its injectable kin. But drugmakers are undeterred by this complication, because a pill even more powerful than semaglutide would no doubt have many customers. In January, Pfizer’s CEO Albert Bourla said that an oral weight-loss drug “unlocks the market,” which he estimated could eventually be worth $90 billion. Pfizer doesn’t have any weight-loss drugs yet but is developing a twice-daily GLP-1 agonist pill; Eli Lilly also has an oral version in the works. Tapper expects those drugs to become available in 2026, and a similar offering from Structure Therapeutics is likely to follow the next year.

    Drugmakers will also likely vie to create drugs with fewer side effects. Novo Nordisk notes that gastrointestinal issues are common with semaglutide; accounts of horrible nausea, constipation, and vomiting have proliferated online. As one actor put it to New York Magazine, people on Ozempic are “shitting their brains out.” With Wegovy, more serious issues, such as pancreatitis, thyroid cancer, and kidney failure, are also possible but are considered rare. Although nothing to scoff at, side effects tend to subside with prolonged treatment and can usually be managed with help from a doctor, said both Fitch and Levy, who regularly prescribe semaglutide to patients with obesity. It’s possible, Levy added, that people experiencing really terrible effects may be getting their drugs from shady compounding pharmacies or even from other countries.

    The fact that people are turning to sketchy outlets to get weight-loss drugs underscores the biggest issue with them: access. Medicare and most private insurance companies don’t cover anti-obesity drugs. (Such drugs are classified as “cosmetic” by the Centers for Medicare and Medicaid Services, and thus don’t qualify for coverage.) “I am hopeful that the price will come down with more competition,” Fitch told me. But there’s no guarantee that will happen: Competition typically makes a product cheaper over time, but research suggests that isn’t always the case in pharmaceuticals. Even if the drugs do become cheaper, they may not become cheap enough. The oral forms of these drugs, some of which could be available by 2026, are expected to cost about $500 a month, Tapper said. By 2030, the cost of obesity drugs could come down to about $350 a month, according to a recent Morgan Stanley analysis, which would still be out of reach for many Americans.

    Levy estimates that the next five years will bring about a “huge explosion” of next-gen obesity drugs. In that case, the market will likely expand to accommodate a variety of drugs with different price points and efficacies. Some people may aim to lose 20 or more percent of their body weight; some may be content with less. The market is so diverse that it will likely “support a broad range of options,” said Tapper, such as cheaper, lower-dose oral drugs for people who have milder medical issues, and more expensive injectables for those with more severe medical concerns. That opens up the possibility that medically mediated weight loss could soon be an option for a far greater proportion of people.

    Regardless of how much these drugs’ costs may decrease, they will always add up if people are paying out of pocket for them. They are meant to be taken long term: Once a person stops taking Wegovy, the weight tends to come right back. The current crop of weight-loss medications are essentially maintenance drugs, much like the cholesterol-busting drug Lipitor, which is taken daily to treat long-term disease. But Lipitor, unlike obesity drugs, is generally covered by insurance. Unless obesity drugs receive the same kind of coverage, no level of improvement will lead them to deliver on what Ozempic is promising us now.

    [ad_2]

    Yasmin Tayag

    Source link

  • Treating Hyperkalemia: Balancing Diet and Mediations

    Treating Hyperkalemia: Balancing Diet and Mediations

    [ad_1]

    When you have hyperkalemia, you have too much potassium in your blood. You can lower your potassium levels with diet, medicine, or both.

    What Your Doctor May Recommend

    Your doctor or health care provider will help you create a treatment plan that’s right for you.

    You may need to follow a diet that’s low in potassium. You may need medication that helps take extra potassium out of your body and keep it from coming back. Or you may need both.

    “An individualized approach is best,” says Ankur Shah, MD, a nephrologist at Brown University’s Warren Alpert Medical School in Providence, RI. Everyone’s different, so you may have unique potassium level goals. Your health care provider will decide what’s best for you and make changes as you go along.

    A good plan may depend on things like:

    • How serious your hyperkalemia is
    • Your medical history
    • Your current potassium levels
    • Your current medications
    • How much potassium is in your regular diet
    • Medication costs vs. benefits
    • How well you can manage diet changes

     

    Diet Changes to Manage Hyperkalemia

    Making changes to your diet can help you control hyperkalemia.

    Your doctor may recommend a low-potassium diet, especially if you get too much potassium from what you normally eat.

    They may tell you to limit certain fruits and vegetables, milk and yogurt, nuts and seeds, and other foods like bran, chocolate, granola, and peanut butter.

    But you may need high-potassium foods to help you stay healthy.

    Foods like meat, fish, and chicken, which have a lot of potassium, are also high in protein, which is an important part of your diet. “High-potassium foods like fruits, vegetables, nuts, and legumes contain nutrients such as vitamins, minerals, and fiber, which have many health benefits,” says Edith Yang, a registered dietitian nutritionist in Monrovia, CA, who specializes in chronic kidney disease.

    Having too little potassium isn’t good either. If your potassium is too low, it may lead to problems like abnormal heart rhythm, muscle weakness, and paralysis.

    “Find the right balance by making sure to include an adequate amount of vegetables on your plate, aiming to eat a rainbow, keeping track of your labs, and working closely with a registered dietitian that specializes in chronic kidney disease,” Yang says.

    Try these strategies:

    Balance your plate. “Make half of your plate veggies, one-fourth protein, and one-fourth carbohydrate,” Yang says. These numbers may need to be adjusted based on how serious your hyperkalemia is, but it’s a good starting point.

    Eat a variety of foods. “A wide variety of whole grains, fruits, and vegetables helps ensure you’re getting adequate nutrition,” Yang says.

    Control your portion size. By limiting your portions, you can get the potassium you need without going overboard. Eat in moderation and watch your serving size.

    Drain or leach certain foods. If you eat canned fruits, vegetables, or meats, drain them first. If you eat high-potassium fresh vegetables, try leaching them first. Peel and place them in cold water. Next, slice them into thin pieces and rinse them in warm water. Then soak them in warm water for 2 or more hours, rinse them again in warm water, and cook them with extra water.

    Avoid certain herbal supplements. “Be careful of any supplements that may have potassium added,” Yang says. Let your doctor know if you start taking a new supplement or medication. Avoid salt substitutes, which are high in potassium.

    Your doctor or dietitian can help create a meal plan and adjust it based on how it works for you.

    Medication for Hyperkalemia

    You may need medication to help lower your potassium levels.

    There are different types of medications. Some lower your potassium quickly, while others do it over time.

    Common treatments for hyperkalemia include:

    Diuretics. When you take diuretics, your kidneys make more urine, which removes potassium. As you urinate more, your body gets rid of more potassium. Diuretics are also known as water pills.

    Potassium binders. This medication binds to extra potassium in your bowels, then removes it when you empty your bowels. A potassium binder may be a powder you mix with water and drink with a meal, or an enema, which goes into your rectum.

    Changes to your current medications. Certain drugs, like blood pressure medications and immunosuppressants, may lead to high potassium. Your doctor may recommend stopping or changing your medication to lower your potassium levels.

    If your potassium level is very high and these don’t help, your doctor may recommend other treatments. “Patients with severe hyperkalemia or who aren’t urinating are more likely to need IV therapies or dialysis,” says Shah. If you have kidney failure, you’ll likely need dialysis.

    How to Find the Right Balance

    Your doctor will decide what potassium level to aim for and what strategies may be best for you.

    Your doctor will monitor you to see how well your diet changes and medication are working. They’ll check your lab results regularly to make sure you’re not getting too much or too little potassium. They’ll also ask you how you feel.

    If you don’t feel well or you feel like you’re not striking a good balance between diet and medicine, talk to your provider about making changes.

    [ad_2]

    Source link

  • Hyperkalemia: Use Good Nutritional Sense

    Hyperkalemia: Use Good Nutritional Sense

    [ad_1]

    About 3 million Americans have high potassium, or hyperkalemia, because of kidney disease, heart failure, or poorly controlled diabetes. Potassium is an important nutrient that helps your nerves and muscles, including your heart, work the right way. But if you have too much in your blood, it can be dangerous and lead to heart problems.

    If you have hyperkalemia, it’s important to work closely with a nutritionist or other health professional to follow a low-potassium diet, says Courtney Barth, a registered dietitian and a nutritionist at the Cleveland Clinic. “It’s a delicate balance — while eating too much can be harmful, eating too little can cause problems, too,” she says.

    What to Expect on Your First Visit to a Dietitian

    If you have a condition like chronic kidney disease, your doctor will check your blood potassium levels often, usually once a month. Bring any information about your blood potassium levels to your first appointment with the nutritionist.

    The levels indicate how high the potassium is:

    • 3.5-5.0 is considered the safe zone.
    • 5.1-6.0 is the caution zone.
    • Higher than 6.0 is cause for more concern.

    Ideally, you want to keep your potassium level under 5, Barth says.

    A nutritionist may also ask you to keep a food diary for about 3 days, says Melissa Prest, a Chicago nutritionist and spokesperson for the Academy of Nutrition and Dietetics. Healthy people should normally get 3,500-4,500 milligrams (mg) of potassium each day. A potassium-restricted diet is usually about half that, or roughly 2,000 mg per day.

    Your nutritionist may also ask you to provide a list of all the medications and supplements you’re on, Prest says. Certain ones can raise potassium levels, including:

    • Blood pressure medications, such as ACE inhibitors, ARBs, and beta-blockers. Kidney patients often take these to control hypertension and help keep their kidneys working well. They also help keep kidney disease from getting worse.
    • Herbal supplements. Some, such as milkweed, lily of the valley, Siberian ginseng, hawthorn berries, preparations from dried toad skin (bufo, chan su, senso), noni juice, alfalfa, dandelion, horsetail, or nettle can raise potassium levels.
    • Over-the-counter nonsteroidal anti-inflammatory drugs (NSAIDs) such as aspirin, ibuprofen, and naproxen. These are common drugs used to reduce fever or treat headaches and other pain.
    • Nutritional supplements. Some nutritional supplements contain potassium. Always tell your health care provider which ones you’re taking.

     

    How a Dietitian Can Help You

    Your dietitian will help tweak your diet to lower your potassium intake. This may include:

    • Advising you about eating the right fruits and vegetables. “Oftentimes, patients tend to overly restrict foods with potassium, so as a result they don’t get enough fruits and vegetables, which are still important for overall health,” Prest says. Some good lower-potassium options include:
      • Apples
      • Apricots (canned in juice)
      • Asparagus
      • Blackberries
      • Blueberries
      • Broccoli
      • Cabbage
      • Carrots
      • Cauliflower        
      • Cherries              
      • Corn
      • Cucumber           
      • Grapes 
      • Kale      
      • Lettuce
      • Mandarin oranges          
      • Peaches (one small fresh or canned)
      • Pears (one small fresh or canned)
      • Pineapple (or pineapple juice)                    
      • Strawberries      
      • Yellow or zucchini squash

    Just remember that for most of these foods, a portion is a half-cup. “If you eat more than a portion or two, it can turn a low-potassium food into a higher-potassium food,” Prest says.

    Fruits higher in potassium include bananas, avocados, melons, oranges, prunes, and raisins. But always check with your nutritionist before cutting out those foods, Prest says. “If your potassium levels are normal, then there’s no reason why you can’t safely eat these fruits, which are all good for you.”

    • Going for the white stuff. Surprisingly, white breads, pastas, and rice are recommended over whole-wheat varieties if you have kidney disease. This is because the more bran and whole grains in the bread, the higher the potassium. “Whole-grain products have more potassium, so they need to be limited if you have kidney disease,” Barth says. Just don’t overdo it on the starchy stuff, she says, because they can cause you to gain weight. That’s bad if your hyperkalemia is caused by a condition like chronic kidney disease, heart failure, or diabetes.
    • Helping you come up with a low-potassium meal plan. Even though you may know what you should and shouldn’t eat, it can be tricky to put it all together so that you only get about 2,000 mg of potassium a day. In general, each day you should aim for:
      • 1-3 servings of low-potassium fruit per day
      • 2-3 servings of low-potassium vegetables per day
      • 1-2 servings of low-potassium dairy like cottage, cheddar, or Swiss cheeses
      • 3-7 servings of low-potassium protein like eggs, chicken, turkey, tuna, shrimp, or unsalted peanut butter
      • 4-7 servings of low-potassium grains, like white rice

    Most of these foods have less than 200 mg of potassium per serving. A dietitian can teach you how to measure portion sizes and calculate the total amount of potassium in each meal so that you stay around an average of 2,000 mg per day.

    • Teaching you how to leach your veggies. You can still enjoy higher-potassium veggies like potatoes, sweet potatoes, carrots, beets, and winter squash, Barth says, as long as you leach them. This will help pull some of the potassium out. Here’s how to do it:
      • Peel and place the vegetable in cold water.
      • Slice the vegetable an eighth of an inch thick.
      • Rinse it in warm water for a few seconds.
      • Soak it for at least 2 hours in warm water.
      • Rinse the vegetable under warm water again for a few seconds.
      • When you cook the vegetable, use five times the amount of water to the amount of vegetable.
    • Showing you how to read food labels. Ingredients are listed in order by weight, with the item of the most weight listed first. “If potassium chloride is in the ingredient list, it has a high potassium content,” Barth says. She also advises looking at the percentage of daily value. It should be less than 6%, or 200 mg, of potassium.

     

    [ad_2]

    Source link