Chronic kidney disease can have many different causes, yet a common chain often appears in the background: stress, metabolic disturbance, and then long-term overload of the kidneys. In this post, we explore how obesity, high blood pressure, type 2 diabetes, and the world of industrially produced, rapidly absorbed carbohydrates are linked to declining kidney function. If you would like to understand why protein often appears in the urine and why the kidneys begin to “overwork themselves,” this talk walks you through the logic in a clear and accessible way.
The content of the video in written form
Hello, this is Dr. Zsom.
Dear patients, well, in the last video we learned that there are some common patterns causing kidney disease in a lot of people. And so, there are two things here that we need to talk about: one is stress, the other one is metabolic syndrome. Metabolic syndrome arises from eating too much but not eating the right things. Okay, so I’m not, I’m not calling this “too much food,” I’m calling this misnutrition—not proper nutrition.
Well, let’s think about this for a minute. So, this is a nice figure showing what happens between 1991 and 2001. So what you see here is how often end-stage, so very advanced kidney disease, is diagnosed in a person per million population. And so you, I think you can very clearly see that compared to this, something must have happened in the 90s, okay, because you had much, much more kidney disease by the end of the decade.
In the meantime, something else happened in the 90s, but let’s see. This shows you how many people are overweight in a percentage ratio; okay, so BMI more than 30, and the percentage of people having this issue. So let’s see: light blue is when you have very little of this issue, and red is when you have a lot. Okay, so let’s see what happened from 1991 to 2008. That’s low back. Let’s see; this happened from 1991 to 2001, and it even got worse by 2008. And in the meantime, this happened, and we think that there is no correlation?
So what happens here? What happens here is that we have misnutrition; in other words, people started eating different in the 90s, even before and, of course, after, but there was this dramatic change in the 90s. So that’s why I showed you that figure, okay. But there is also something else that I didn’t shape, and that’s mishandling of stress. That’s a more chronic problem, not at the individual level but at the society level. And in the meantime, of course, we have type 2 diabetes connected with misnutrition, okay, appearing in children. So usually in the past, adult type 2 diabetes appeared after the age of 40 or 50; now you have seen teenagers. So something must have happened, namely misnutrition and mishandling of stress.
So let’s talk about this, but first, let’s understand what happened in the 80s and 90s, okay. This is the causes of end-stage, so advanced kidney disease. These have been the people who were starting on dialysis, and we are asking the question: okay, why did they develop kidney disease? And let’s look at this thing here, okay: type 2 diabetes. Okay, there’s no mystery here; type 2 diabetes increased, kidney disease increased, and of course, high blood pressure. And high blood pressure, so he says it’s a disease of blood vessels that is caused by a lot of salt intake and other issues; okay, complex issues, but connected with misnutrition.
So let’s look at this poor mouse, okay. So here’s what happens: you take high fructose corn syrup, okay, this beautiful liquid here, gold and nice and beautiful, and let’s feed this mouse. Okay, it was a whole lot smaller than this before you started doing that with high fructose corn syrup. See what happened. And it’s a mystery to me why this particular study is not known by pretty much everyone because it’s kind of important, okay. So as you can see, this was in a physiology journal and it was published a long time ago. So here’s what this shows: if you give normal food, usual food, to the mice, then what happens is that they have a fairly okay triglyceride level, okay, they have pretty normal cholesterol, uric acid, and insulin levels.
Now, okay, you give them sugar, a lot of sugar, and you can see that things are not very much different. Now you give them high fructose corn syrup, okay, and here’s what happens: the triglyceride level more than doubles, cholesterol remains largely the same, uric acid remains largely the same, yet their insulin level goes up. Okay, and so what happens in these poor animals in terms of their kidney function? Well, the protein in the urine, okay, doubles. It’s a reflection of the filtering capacity; okay, it goes down. So that means that the kidneys will begin—again, is working very, very hard—and the pressure in the small blood vessels within the kidney goes up because of misnutrition.
So here’s the problem: this does not only happen in mice, but it also happens in people. Okay, and so although these are on purpose not necessarily in English, okay, but you see here that glucose-fructose syrup and fructose are ingredients in, you know, cereal and soft drinks and certain bakery products, etc., okay. But these things are made to look so nice; they are sugar-coated raisins and then you think, “Oh my God, okay, these are all very good things,” and yet they have a common denominator: high fructose corn syrup.
Now, these then result in the metabolic syndrome, okay, with multi-organ consequences. So you have heart disease, okay; you have blood vessel issues, okay; you have lipid problems such as high triglycerides; you have hypertension, high blood pressure. Really, what you have is inflammation in blood vessels, and high blood pressure is a symptom of that. You have type 2 diabetes, adult-type diabetes; you have dementia; you have cancer; you have polycystic ovarian syndrome and fatty liver disease.
But remember, this was done by internal medicine physicians and we are nephrologists, so let’s add a few things. High triglycerides and low HDL, HDL being the good cholesterol, is typically a kidney disease, okay, and so you will have a lot of this. You have gout, you have issues, you have an altered gut flora, you have inflammation in the blood vessels, you have atherosclerosis because of inflammation. Heart, brain, causes strokes and organ infarction. And you have chronic kidney disease, you see, okay. You have first too high filtering and then, when the kidney tires out, all of your kidney functions sooner or later will start to fail. And an early signal and only sign of this is albuminuria, that is, protein in the urine, and salt retention, that is, it’s difficult to get rid of salt and fluid, okay; it builds up in your body.
So then, high fructose corn syrup, the glory of the food industry, okay, and please understand that high fructose corn syrup is very cheap, it’s easy to produce and it’s easy to transport. And then you put those things in these very shiny, beautiful, and possible, okay, and then you forget about it. And then what you do is you get a lot of fructose in your body or glucose in your body; it’s the same thing. Why is this a problem? It’s a problem because these things are directly linked to food ulcers, myocardial infarction, metabolic syndrome in general, and these things are linked to that need for dialysis.
So to understand why all of this is, we need to look at stress and how we handle stress. So here is stress, right? You have a need for a fast energy source, okay; the brain and the muscle both need a fast energy source. So what is this fast energy source? Well, it’s simple carbohydrates, high glucose like fructose. So glucose and fructose is a very good thing when you have stress because what you do is you fight or flight, and both need brains and muscle, okay. So you have stress hormones released and they cause release of carbohydrates from energy stores in muscle and in the liver. So the sugar goes into your blood, and then the blood sugar will deliver sugar to your brain and to your muscle, and then you consume this sugar, okay.
So here’s what’s gonna happen: if you use a lot of carbohydrates in terms of sugar consumption because your fight or flight began, you replace that by something like glucose or fructose-containing beverages or foods. And it’s a very good thing because you need a fast energy source and you get it. I mean, you have high fructose corn syrup, you have glucose of any form and shape, and you replace what you have consumed. So far, so good.
But then, what happens today in the majority of cases? Not this, but this. Look, this is how stress appears in our everyday life: not like this, not like this, okay. Stress while sitting—no exercise. So you drink a lot of caffeine, and caffeine is really doing a good job because it mimics the effect of exercise, but it’s not real exercise, is it? As I’ve shown you, okay, you have a high carbohydrate intake, and I will tell you why, okay; and you eat a lot of fat. And I will tell you why—why carbohydrates and fats? Okay, they cause euphoria. So when you’re depressed, do you eat? Okay. You eat a lot of salt as preservatives. Well, one of the most ancient preservatives is salt. So since you don’t grow food, you know, on your roots, okay, but it comes from somewhere, it needs to be preserved, okay; and there’s a lot of salt to preserve food.
So in our nice urban environment, okay, we eat a lot, we don’t necessarily eat the right things, yeah, we have a high salt intake, okay, and then we do not consume all the energy that we take in. You know, on top of this comes mishandling of stress because when you have stress here, carbohydrates are not consumed why because you don’t have fight or flight you just continue sitting. Okay, and so what happens? Here comes insulin, and insulin makes the unconsumed carbohydrate go back to the stores. So insulin makes these carbohydrates go back to the stores, okay, and to the storage, I mean, in the muscle and then the liver, okay.
So what happens is that since insulin acts a long time, sooner or later your blood sugar will just drop down, okay, as it goes back to the stores, into the storage places, and your blood sugar drops and you become hungry, okay. So now if, on top of this, you have a condition called insulin resistance, then you really have a problem because insulin action continues and the insulin is gonna work on fat cells rather than on muscle or liver.
Now let’s see how that works out. So first of all, we need to understand one thing: that insulin is really not designed for fast peaks of blood sugar, okay, because insulin is designed for slow absorption of carbohydrates from the gut, okay; so it acts for hours, okay, it has a slow action. Now imagine that you drink a soft drink with concentrated, diluted simple carbohydrates. They’re gonna have a fast absorption, so your blood sugar goes up very high. And as your blood sugar goes up very high, a lot of insulin is produced, but then the insulin, okay, not knowing that your carbohydrate absorption is going to be very fast and lasting for a short time, it acts a long time, okay. So what happens is an insulin makes your blood sugar drop and then you are going to get very hungry. Yeah, insulin has other effects; for instance, it may cause salt retention, okay, and more atherosclerosis of blood vessels. So if you abuse your insulin by having a lot of stress and/or taking in a lot of easy-to-absorb carbohydrates, then your insulin is gonna work and work and work and work, and there’s going to be a defense against high insulin levels in the blood from muscle, from the muscle tissue, and you end up with insulin resistance in the muscle.
So here’s what’s going to happen: you feel tired and hungry. Especially if you have stress, you eat food, but not just any food, okay; you eat something that has concentrated, easy-to-absorb carbohydrates. So now you have a fast peak, okay, of blood sugar. Why? Because you first of all you may still have stress hormones around; second of all, you easily and very fast absorb your carbohydrates. So that causes a lot of insulin production, and because you have a high insulin all the time in your blood, your muscle tissue… now imagine if you have muscle atrophy, so you have very little muscle mass because you don’t exercise, okay; that just adds to the problem. So your muscle tissue will resist your insulin, okay, or you don’t have enough muscle tissue to begin with, and so insulin instead of working in muscle tissue is going to work on fat cells, okay.
So where does your carbohydrate go? Not in muscle stores, but in fat stores, okay. And so you are gonna add fat. So are we really that surprised that you abuse your insulin, okay, and you’re going to get insulin resistance? That you don’t have muscle mass and you’re going to have insulin resistance? Okay. After all, one of the most important organs that uses insulin is the muscle, right? So where do we store carbohydrate energy? In the muscle. If you don’t have muscle and the muscle you have is resistant to insulin, then you are going to direct your insulin into fat cells. They are gonna welcome you, okay; so that’s the problem. So insulin goes where it is still welcome: adipose tissue, otherwise known as fat cells. Mass—no worries, there’s fat masses, okay. And so now you have insulin resistance and now you have the typical insulin resistance syndrome; for instance, in polycystic ovary syndrome, okay, adding infertility and other issues to the usual insulin resistance problems that we already know, okay.
So here is what happens then: we have two kinds of stress and two kinds of sugars, right? So there’s stress with or without fuel consumption. If you have fuel consumption, then even high fructose corn syrup is a good thing, why? Because you consume your fructose and glucose. But if you just sit around and you are kind of stressed and watch television, okay, then what’s going to happen is that the sugar is not consumed, and so it goes back to stores, but your blood sugar is going to drop and you’re going to be hungry, okay.
And then you have two kinds of sugars. One is the slow-absorbing kind, okay, for instance, in potatoes or pasta; yeah, you have a lot of sugar, but it gets absorbed more smoothly, okay, even if you have fruits with a lot of fiber. So that’s very good; that’s what insulin is designed for. But now you have concentrated simple sugars in a solution, in other words, in the water, okay. So what happens is that you’re gonna absorb your sugars very fast; with that you have a high blood sugar peak, a lot of insulin is produced, and you develop insulin resistance if it goes on for years. And with insulin resistance, you’re gonna direct your insulin to fat cells, okay, and so you add the metabolic syndrome.
Yeah, let’s go back from internal medicine to nephrology. And so what you are going to see is that at the extreme of metabolic syndrome, you are gonna get kidney disease. Okay, not decreased filtering function with bad labs—that comes later—you have overwork of the kidneys; the kidneys work more than they should, the kidneys filter too fast. Okay, so ultimately, when the kidneys overwork, then sooner or later they would tire out. You develop kidney disease with scarring and failing function. Not just one function, but all functions of the kidneys are going to be affected.
So how do we summarize all of this? The problem that is created by industry is going to be sold by industry, by dialysis, okay. And so what we are seeing here is that we need to understand that stress needs to be handled properly with exercise and thinking involved, and we need to eat the right thing. Because if we don’t—if we eat things that are absorbed very fast and cause a blood sugar peak, they cause insulin overwork and that affects your blood vessels, that affects your kidneys, and you are gonna get true kidney disease in the process, okay. And in the next video, we are going to see how it works out in the kidney; so in other words, we are gonna see what it means that the kidneys overwork. But until then, thank you for your attention and goodbye for now.
