Make Your Kidneys Last a Lifetime | Dr Rick Johnson - Wise Athlete Podcast

@Joseph_Lavelle Your latest podcast is really interesting with easily actionable information.
Make Your Kidneys Last a Lifetime | Dr Rick Johnson

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Thanks. Dr Johnson is very good. I have been following his advice to preserve my kidney function ever since I first had him on WiseAthletes.com.

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@Joseph_Lavelle
Is he saying that all fruit should be avoided? Seems like an extreme position.

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@Tim No, he says fruit JUICE should not be consumed regularly. Fruit does not have the same effect due to the fiber which slows absorption and limits quantity of fruit consumed. There is probably some nuance here as not all fruit is the same, but Dr Johnson said whole fruit is good. His biggest issue is with all high sugar drinks. I recall he made an exception for Gatorade G2 (lower sugar) consumed WHILE exercising.

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As usual it’s the dose that makes the poison. :slightly_smiling_face:

From his book Nature Wants Us to Be Fat:

“For intake of natural sugars present in food, I recommend three or four servings of whole fruit each day, ideally separated. Fruits containing more than 8 grams of fructose per serving should be limited, or eaten in half-serving quantities. Dried fruits and fruit juices should only be eaten sparingly, if at all. Jams, jellies, applesauce, and other foods with concentrated fruits should generally be avoided, but you can review the amount of total sugars* per serving on these products’ nutrition labels. If a serving contains fewer than 8 grams of total sugar, it represents 4 grams of fructose or less and is fine to eat.”

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He never answered your question about whether damage can be reversed or only prevented. Weird

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@medaura Darn. You are correct. It’s always a rush to finish before the carriage turns into a pumpkin. My fear and belief is that the damage is not reversible, which is why kidney function declines with age…keep your kidneys happy! I’ll send Dr Johnson an email on this question.

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I’ve got depression mentality too but it would be good to get expert opinion. It might be that he doesn’t know for sure and that’s probably why he dodged the question.

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Given the links between CKD and senescence it strikes me that senomorphic approaches might be best

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@John_Hemming thanks for the paper. It is exactly on point to the question. In all things senescence, it is better to avoid it than try to resolve it.

I think you are right that avoiding senescence is ideal, but if you already have senescent cells then something needs to be done.

Personally I think a lot are simply stem cells that have failed to differentiate and that kicking them through differentiation is the way forward. However, others go for senolytics as a solution. The difficulty as I see it, however, is that you still don’t have the cells that the body needs if you just kill off the failures (although homeostasis will have some effect).

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From the paper…an answer to the question about reversing CKD

“ Though effective treatments to halt or reverse CKD are extremely limited, regulating renal senescence is expected to provide a new target for its intervention.”

And what to do, from the same paper:

“ A recent study showed that metformin exerts its anti-senescence effect by targeting senescent mesenchymal stem cells (MSC) in CKD (Kim et al., 2021). Since the side effects of metformin are minimal and are likely to be reversible, it is expected to be applicated in healthy individuals to block senescence-related renal changes (Barzilai et al., 2016). At present, the mTOR inhibitors mainly include rapamycin and its analog rapalog. They have attracted high attention in the treatment of renal diseases for their positive effect on renal senescence and fibrosis (Shavlakadze et al., 2018).”

“ CR mitigates senescence-associated renal changes by activating SIRT1 and AMPK, blocking mTOR and NF-κB signaling pathways, and inhibiting the activity of endothelin-1 (ET-1) (Wang et al., 2021), thereby promoting autophagy and reducing oxidative stress (Ning et al., 2013).”. (Perhaps fasting?)

A full list of interventions:
Therapeutic approaches against cellular senescence.

Senotherapy Agents
Senolytics dasatinib and quercetin Hickson et al., (2019), ABT-263 Chang et al., (2016), FOXO4-DRI Zhang et al., (2020), ABT-737 Lisowska et al., (2012), fisetin Zhu et al., (2017), 17-DMAG Litjens et al., (2006), A1331852 Zhu et al., (2017), A1155463 Zhu et al., (2017), panobinostat Samaraweera et al., (2017), BPTES Johmura et al., (2021), EGCG Kumar et al., (2019)
Senomorphics metformin Kim et al., (2021), rapamycin Shavlakadze et al., (2018), bardoxolone Nagasu et al., (2019), pyrrolidine dithiocarbamate Okabe et al., (2013), methionine Wang et al., (2019), mitoq Xiao et al., (2017), SkQ1 Anisimov et al., (2011), ruxolitinib Griveau et al., (2020), flavonoids Lim et al., (2015)
Rejuvenating agents resveratrol He et al., (2016), SRT1460 Zhao and Yu., (2021), SRT1720 Ren et al., (2017), SRT2183 He et al., (2010), D-Pinitol Koh et al., (2018), Isoliquiritigenin Huang et al., (2020), Rutin Khajevand-Khazaei et al., (2018), klotho Zou et al., (2018), PPAR-γ agonists Xu et al., (2020)
Others calorie restriction Wang et al., (2021), exercise Kim et al., (2020), TA-65 Salvador et al., (2016), ACEI/ARB Jacobi et al., (2011), DHA Forman et al., (2020), immunomodulation Schroth et al., (2020)

ACEI, angiotensin-converting enzyme inhibitor; ARB, angiotensin receptor blocker; DHA, dehydroascorbic acid; EGCG, epigallocatechin gallate; FOXO4-DRI, Forkhead box O-4-D-Retro-Inverso; PPAR-γ, peroxisome proliferator-activated receptor-γ.

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Keeping an eye on improvements in Cystatin-C would give an indication as to whether kidney function is improving.

Creatinine in theory can do this as well, but it is a more unreliable measurement.

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@Joseph_Lavelle, @medaura

Kidney disease is thought to be a progressive, irreversible illness. However, a small percentage of cases can in fact be turned around, if not completely cured. Most cases of chronic kidney disease are caused by diabetes or hypertension. If the cause is diabetes, then the kidneys will probably continue to deteriorate at a slower or more rapid pace, depending on the patient’s age, diet, treatment, etc. But if the cause is hypertension, then a lucky 7-15% of patients will see a reversal of symptoms, including a significant increase in GFR.

I offer myself as Exhibit A. With the help of lisiniprol, an ACE-inhibitor, together with a strict adherence to the renal diet and a big wet kiss from Lady Luck, my GFR rose over the last five years from 16 to 44.

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Very nice. And congrats.

And, I think you made the point very well that avoidance is far better than recovery even if recovery is possible. Get and stay metabolically healthy / flexible (HbA1c around 5.0), and get and keep the BP at (or even a little below) 120/80

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Dr Johnson says…
“There is definite evidence that aging associated kidney disease can be prevented by eating a healthy diet and likely reducing carbohydrates.
However , it is harder to reverse scars. However, there is some evidence that there can be some healing of disease even when it is associated with scarring. This has been particularly shown with diabetic kidney disease, in which curing diabetes by transplantation of the pancreas can lead to improvement in scarred kidneys over time. So it is possible, but just not that common.”

I followed up about recovering kidney function after reducing BP….

“Yes, for sure. In particular, blocking the renin angiotensin system can improve micro vascular disease, especially hyalinosis. Mice placed on RAS inhibitors live longer. Leon Fine was once asked “ but is it good to live longer if you continue to age?” And he smiled and said- oh these mice still think they are young and even stay sexually active!!”

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@Joseph_Lavelle
The chances of getting a pancreas transplant to cure Type 1 diabetes are pretty low, and the chances of getting a successful transplant are even lower. When the disease is well controlled, a diabetic can live a life that is mostly free of complication. However, the nature of the illness is such that it reduces a patient’s life expectancy by an average of 12 years. Fortunately, new advances in stem cell therapy may provide not a treatment but a cure.

Here’s a recent documentary on the subject.

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