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Tag: kidney function

  • Can Vegan Fecal Transplants Lower TMAO Levels? | NutritionFacts.org

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    If the microbiome of those eating plant-based diets protects against the toxic effects of TMAO, what about swapping gut flora?

    “Almost 2,500 years ago, Hippocrates stated that ‘All disease begins in the gut.’” When we feed our gut bacteria right with whole plant foods, they feed us right back with beneficial compounds like butyrate, which our gut bugs make from fiber. On the other hand, if we feed them wrong, they can produce detrimental compounds like TMAO, which they make from cheese, eggs, seafood, and other meat.

    We used to think that TMAO only contributed to cardiovascular diseases, like heart disease and stroke, but, more recently, it has been linked to psoriatic arthritis, associated with polycystic ovary syndrome, and everything in between. I’m most concerned about our leading killers, though. Of the top ten causes of death in the United States, we’ve known about its association with increased risk of heart disease and stroke, killers number one and five, but recently, an association has also been found between blood levels of TMAO and the risks of various cancers, which are our killer number two. The link between TMAO and cancer could be attributed to the inflammation caused by TMAO, but it could also be oxidative stress (free radicals), DNA damage, or a disruption in protein folding.

    What about our fourth leading killer, chronic obstructive pulmonary disease (COPD), like emphysema? TMAO is associated with premature death in patients with exacerbated COPD, though it’s suspected that it’s due to them dying from more cardiovascular disease.

    The link to stroke is a no-brainer—no pun intended. It is due to the higher blood pressure associated with higher TMAO levels, as well as the greater likelihood of clots forming in those with atrial fibrillation. Those with higher TMAO levels also appear to have worse strokes and four times the odds of death.

    Killer number six is Alzheimer’s disease. Can TMAO even get up into our brains? Yes, TMAO is present in human cerebrospinal fluid, which bathes the brain, and TMAO levels are higher in those with mild cognitive dysfunction and those with Alzheimer’s disease dementia. “In the brain, TMAO has been shown to induce neuronal senescence [meaning, deterioration with age], increase oxidative stress, impair mitochondrial function, and inhibit mTOR signaling, all of which contribute to brain aging and cognitive impairment.”

    Killer number seven is diabetes, and people with higher TMAO levels are about 50% more likely to have diabetes. Killer number eight is pneumonia, and TMAO predicts fatal outcomes in pneumonia patients even without evident heart disease. Kidney disease is killer number nine, and TMAO is strongly related to kidney function and predicts fatal outcomes there as well. Over a period of five years, more than half of chronic kidney disease patients who started out with average or higher TMAO levels were dead, whereas among those in the lowest third of levels, nearly 90% remained alive.

    How can we lower the TMAO levels in our blood? Because TMAO originates from dietary sources, we could limit our intake of choline- and carnitine-rich foods. They’re so widespread in foods,” though we’re talking about meat, eggs, and dairy. “Therefore, restriction of foods rich in TMA-containing nutrients may not be practical.” Can we just get a vegan fecal transplant? “Vegan donors provided the investigators with a fresh morning fecal sample…”

    If you remember, if you give a vegan a steak, despite all that carnitine, they make almost no TMAO compared to a meat-eater, presumably because the vegan hasn’t been fostering steak-eating bugs in their gut. See below and at 3:40 in my video Can Vegan Fecal Transplants Lower TMAO Levels?.

    Remarkably, even if you give plant-based eaters the equivalent of a 20-ounce steak every day for two months, only about half start ramping up production of TMAO, showing just how far their gut flora has to change. The capacity of veggie feces to churn out TMAO is almost nonexistent. Instead of eating healthier, what about getting some vegan poop?

    In a double-blind, randomized, controlled trial, research subjects either got vegan poop or their own poop back through a hose snaked down their nose, and it didn’t work.

    First of all, the vegans recruited for the study started out making TMAO themselves, in contrast to the other study, where they didn’t make any at all. This may be because the earlier study required the vegans to have been vegan for at least a year, and this study didn’t. So, there wasn’t much of a change in TMAO running through their bodies two weeks after getting the vegan poop, but the vegan poop they got seemed to start out with some capacity to produce TMAO in the first place.

    So, the failure to improve after the vegan fecal transplant “could be related to limited baseline microbiome differences and continuation of an omnivorous diet” after the vegan-donor transplant. What’s the point of trying to reset your microbiome if you’re just going to eat meat? Well, the researchers didn’t want to switch people to a plant-based diet since they knew that alone can change our microbiome, and they didn’t want to introduce any extra factors. The bottom line is that it seems there may not be any shortcuts. We may just have to eat a healthier diet.

    Doctor’s Note

    Want to become a donor? Find out How to Become a Fecal Transplant Super Donor.

    For more on TMAO, check out related posts below. 

    See the microbiome topic page for even more.

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    Michael Greger M.D. FACLM

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  • Eating an Anti-Inflammatory Diet for Lupus  | NutritionFacts.org

    Eating an Anti-Inflammatory Diet for Lupus  | NutritionFacts.org

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    Green smoothies are put to the test for the autoimmune disease lupus.

    There are dozens and dozens of journals I try to stay on top of every month, and one I always anticipate is The International Journal of Disease Reversal and Prevention, a peer-reviewed medical “journal created to document the science of nutrition and lifestyle to prevent, suspend and reverse disease,” with an editor-in-chief no less prestigious than Dr. Kim Williams, past president of the American College of Cardiology. I was honored to join its editorial advisory board, along with so many of my heroes. The best part? It’s free. Go to IJDRP.org and put in your email to subscribe at no cost, and you’ll be alerted when new issues are out, which you can download in full in PDF form. (Did I mention it’s free?)

    When it comes to chronic lifestyle diseases, wrote Dr. Williams, “Instead of preventing chronic lifestyle diseases, we [doctors] manage. Never cure, just mitigate. Why? Because of finance, culture, habit, and tradition.” There are many of us, though, who “envision a world where trillions of dollars are not spent on medical care that should never have been necessary, but rather on infrastructure, environment, education, and advancing science. For this reason, comes The International Journal of Disease Reversal and Prevention (IJDRP).” After all, wrote the journal’s co-founder, “Without data, you’re just another person with an opinion.”

    To give you a taste of the journal: How about pitting plants against one of the most inflammatory diseases out there—lupus, an autoimmune disease in which your body can start attacking your DNA? Kidney inflammation is a common consequence, and even with our armamentarium of immunosuppressant drugs and steroids, lupus-induced kidney inflammation can lead to end-stage renal disease, which means dialysis, and even death. That is, unless you pack your diet with some of the most anti-inflammatory foods out there and your kidney function improves so much you no longer need dialysis or a kidney transplant. Another similar case was presented with a resolution in symptoms and normal kidney function, unless the patient deviated from the diet and his symptoms then reappeared.

    As I discuss in my video Anti-Inflammatory Diet for Lupus, even just cutting out animal products can make a difference. Researchers randomized people to remove meat, eggs, and dairy from their diets without significantly increasing fruit and vegetable intake and found that doing just that can lower C-reactive protein levels by nearly a third within eight weeks, as you can see below and at 2:21 in my video. (Our C-reactive protein level is a sensitive indicator of whole-body inflammation.)

    But with lupus, the researchers didn’t mess around. Each day, the study subjects were to eat a pound of leafy greens and cruciferous vegetables like kale, fruits like berries, and lots of chia or flax, and drink a gallon of water. We’re talking about a green smoothie diet to extinguish lupus flares. (Note, though, that if your kidneys are already compromised, this should be done under physician supervision so they can monitor your electrolytes like potassium and make sure you don’t get overloaded with fluid.) Bottom line? With such remarkable improvements due to dietary changes alone, the hope is that researchers will take up the mantle and formally put it to the test. 

    Reversals of autoimmune inflammatory skin disease can be particularly striking visually. A woman with a 35-year history of psoriasis that had been unsuccessfully managed for 19 years with drugs suffered from other autoimmune conditions, including Sjogren’s syndrome. She was put on an extraordinarily healthy diet packed with greens and other vegetables, fruits, nuts, seeds, avocados, and some whole grains, and boom! Within one year, she went from 40 percent of her entire body surface area inflamed and affected down to 0 percent, completely clear, and, as a bonus, her Sjogren’s symptoms resolved, too, while helping to normalize her weight and cholesterol. You can see before and after photos below and at 3:39 in my video. 

    I think I only have one other video on lupus: Fighting Lupus with Turmeric: Good as Gold. It’s not for lack of trying, though. There just hasn’t been much research out there.

    I talk about another autoimmune disease, type 1 diabetes, in Type 1 Diabetes Treatment: A Plant-Based Diet.

    To read and subscribe—for free—to The International Journal of Disease Reversal and Prevention, visit www.IJDRP.org.

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    Michael Greger M.D. FACLM

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  • Can We Safely Use Aluminum Foil, Bottles, and Pots?  | NutritionFacts.org

    Can We Safely Use Aluminum Foil, Bottles, and Pots?  | NutritionFacts.org

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    DNA damage is assessed in users of aluminum cookware.

    “Over the last decades, the toxicity of aluminum for humans has been heavily discussed and is still not completely clarified.” Those occupationally exposed to aluminum—for instance, in smelter plants—suffer from oxidative stress and free radicals that can damage their DNA. What about just using aluminum cookware? Articles like “Metal Exposures from Aluminum Cookware: An Unrecognized Public Health Risk in Developing Countries,” suggesting an “unrecognized public health risk,” were limited to the developing world where “cookware is made in informal shops by casting liquid aluminum melted from a collection of scrap metal,” including the likes of vehicle radiators, lead batteries, and computer parts, which is how you can get so much lead leaching into people’s food. 

    Then “The Relationship Between Plasma Aluminum Content, Lymphocyte DNA Damage, and Oxidative Status in Persons Using Aluminum Containers and Utensils Daily” was published, suggesting that aluminum itself may be harmful. Most of our aluminum exposure comes from processed junk food containing aluminum additives, “including those within some processed cheeses, baking powders, cake mixes, frozen dough, and pancake mixes.” However, about 20 percent of the daily intake of aluminum may come from aluminum cooking utensils, such as “pans, pots, kettles, and trays.” 

    Might this cause a problem? Researchers took blood from consumers who used aluminum cookware versus those who did not and found that not only did the aluminum users have twice the level of aluminum in their blood, as you can see below and at 1:33 in my video Are Aluminum Pots, Bottles, and Foil Safe?, but they had more free radical damage of their body fats and proteins. What’s more, the total antioxidant capacity of the bloodstream of those using aluminum cookware was compromised, so they suffered significantly more DNA damage. 

    Indeed, as you can see below and at 1:52 in my video, those with the highest levels of aluminum in their blood tended to suffer significantly more damage to their DNA. No surprise, since “aluminum is considered to be a pro-oxidant agent.”

    These folks weren’t just casually using aluminum pots, though. Specifically, they use them every day to cook and store acidic foods, like yogurt and tomato sauce, which can leach out more aluminum. But, even using “camping dishes,” which tend to be aluminum since it’s so light, for just one week, could greatly exceed the tolerable weekly intake guidelines, especially for children, if you incorporated something acidic, like marinating a fresh catch in lemon juice. Once in a while won’t make much difference, but these findings suggest that you may not want to cook in aluminum day in and day out. 

    What about aluminum drinking bottles? They’re nice and light, but children drinking two cups a day of tea or juice from them could exceed the tolerable aluminum exposure limit. So, out of an abundance of caution, safety authorities like the German Federal Institute for Risk Assessment “recommend that consumers avoid the use of aluminum pots or dishes for acidic or salted foodstuffs such as apple sauce, rhubarb, tomato puree, or salt herring…thus prophylactically avoiding the ‘unnecessary ingestion’ of aluminum.” 

    What about aluminum foil? Wrapping and baking food in aluminum foil is a common culinary practice. The concern is that this could represent “a potentially hazardous source of aluminum in the human diet.” When put to the test, there was leakage of aluminum from the foil to the food, but the amount was so small that it would be more of an issue for small children or those suffering from diminished kidney function. 

    What about just wrapping food in foil to store it in the refrigerator? Only marginal increases in aluminum are seen—except when the food is in contact with the foil and, at the same time, certain other types of metal, such as stainless steel, which is largely iron. That sets up a battery and “can lead to tremendous food aluminum concentrations.” For example, as you can see below and at 4:34 in my video, the aluminum levels in a ham before and after a day coveredin foil are negligible; there’s hardly a bump in the foil-covered ham. But, if that same foil-wrapped ham sits on top of a steel tray or serving plate for a day, the aluminum levels in the ham shoot up.

    Finally, you know how aluminum foil is often glossy on one side and dull on the other? Which would be worse? Fish fillets were baked and grilled both ways, wrapped with the glossy side out versus the dull side out, and no significant difference was found.

    This is the first in a series of three videos on cookware. Stay tuned for Stainless Steel or Cast Iron: Which Cookware Is Best? Is Teflon Safe? and Are Melamine Dishes and Polyamide Plastic Utensils Safe?.

    I’ve discussed aluminum in antiperspirants, food, medications, and tea. Check out the related posts.

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    Michael Greger M.D. FACLM

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  • The Neurotoxin in Star Fruit  | NutritionFacts.org

    The Neurotoxin in Star Fruit  | NutritionFacts.org

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    Starfruit contains a neurotoxin known as caramboxin that can cause irreversible brain damage at high enough doses. 
     
    If someone walks into the emergency room with intractable hiccups, one of the questions the ER physician should ask is: Have you been eating star fruit? 
     
    In my video cautioning about oxalate-rich foods, Kidney Stones and Spinach, Chard, and Beet Greens: Don’t Eat Too Much, I talked about star fruit nephrotoxicity—that is, kidney toxicity. “Excessive consumption of star fruit has been associated with the development of oxalate nephropathy,” kidney damage. Star fruits aren’t that big. Less than a cup of star fruit juice or “three fruits of star fruit” can result in acute star fruit nephrotoxicity. Indeed, “ingestion of even modest quantities of star fruits can produce oxalate nephropathy” (kidney problems). “It is essential to prevent star fruit nephrotoxicity by educating the public and especially diabetics to avoid consuming star fruit, especially on an empty stomach or in a dehydrated state.”  
     
    Let’s talk about the neurotoxicity. As I discuss in my video Neurotoxicity Effects of Starfruit, we’ve known about the neurotoxic effects for more than a quarter century, but few seem to be familiar with the syndrome. As you can see below and at 1:17 in my video, it most commonly starts with hiccups, then can worsen rapidly, especially in those who already have compromised kidney function. Why? Because “this fruit contains a powerful neurotoxin that can accumulate in the blood, cross the blood–brain barrier…and eventually cause irreversible damage” to the brain. The toxin itself, named caramboxin, is normally excreted by the kidneys, so it is especially toxic to those with renal insufficiency—that is, compromised kidney function—so much so that for those with severe chronic kidney disease, a single-star fruit can put someone in seizures within three hours, a coma, then death within three days. 

    In a series of about a hundred cases of toxicity, consumption ranged between just half a star fruit up to 50 star fruits, with an average of about 4, but most of those participants had some sort of pre-existing kidney disease. The average number of star fruits eaten by those in the normal kidney function group before their toxic dose was more like 15. So, people with normal kidney function may be more likely to suffer from kidney damage than brain damage, which starts with the consumption of around four star fruit. 
     
    The bottom line is that those with chronic kidney disease should avoid star fruit to avoid severe intoxication. In Brazil, where the fruit is popular, there are laws to alert people about the risks. Because of its neurotoxins, star fruit should be prohibited for patients with chronic kidney disease, but even those with normal kidney function may want to avoid the fruit—just something to think about before you reach for the stars. 
     
    For more on kidney health, see related videos below. 

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    Michael Greger M.D. FACLM

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