Integrative Kidney

Demystifying Oxalate: The Antinutrient Unveiled

When navigating the terrain of nutrition, we often focus on essential nutrients, overlooking the complex world of “antinutrients.” Antinutrients are compounds found in our daily food that might block or reduce our body's ability to absorb essential nutrients. One such critical antinutrient playing a significant role, especially for those concerned with kidney health, is oxalate.

By Majd Isreb, MD, FACP, FASN, IFMCP

A Glimpse into the World of Antinutrients

1. Phytic Acid: The mineral blocker

• Sources: Grains, seeds, nuts, and legumes are rich in phytic acid.
• Effects: Phytic acid can hinder the absorption of crucial minerals such as iron, zinc, calcium, and magnesium. Phytic acid is helpful in preventing the absorption of plant phosphate. This decreases the phosphate load kidney patients may experience when consuming a plant-dominant diet.
• Management: Techniques such as soaking, sprouting, and fermenting can significantly diminish phytic acid content, rendering the nutrients in these foods more bioavailable.

1. Lectins: Gut’s nemeses

• Sources: Legumes like beans and lentils, tomatoes, eggplants, and certain grains are known lectin sources.
• Effects: By binding to the gut wall, lectins can disrupt nutrient absorption.
• Management: Cooking, particularly boiling, can degrade most of the harmful lectins. Pre-soaking beans and legumes also aids in lectin reduction.

1. Tannins: The iron obstructor

• Sources: Predominantly found in tea, coffee, and some fruits.
• Effects: Tannins can obstruct non-heme iron absorption, potentially leading to deficiencies.
• Management: Diversifying iron sources and not solely depending on plant-based ones can mitigate the impact of tannins on iron absorption.

1. Trypsin Inhibitors: The protein barrier

• Sources: Abundantly present in legumes like soybeans.
• Effects: They can obstruct protein digestion by targeting the enzyme trypsin.
• Management: Comprehensive cooking usually neutralizes these inhibitors.

1. Goitrogens: The thyroid disruptors

• Sources: Cruciferous vegetables like broccoli, Brussels sprouts, and cauliflower contain goitrogens.
• Effects: These compounds can disrupt thyroid function by inhibiting iodine uptake, vital for thyroid hormone synthesis.
• Management: Regular cooking can substantially neutralize most goitrogenic compounds.

You can see from the above list that many of these “antinutrients” are present in foods that have proven health benefits.

Zooming into oxalate

Oxalate, also known as oxalic acid, is a naturally occurring compound found in many plant-based foods. It's known for its ability to form insoluble crystals when it binds with minerals like calcium and magnesium. These crystals can interfere with mineral absorption. Oxalate can also contribute to the formation of kidney stones in susceptible individuals. For those focusing on integrative approaches to kidney diseases, understanding oxalates is crucial.

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Oxalate content in common foods:

The oxalate content varies considerably among different foods:

• Very High: Spinach, rhubarb, beet greens, almonds, and Swiss chard contain more than 100 mg of oxalate per serving.
• Moderately High: Foods like okra, sweet potatoes, raspberries, and black tea contain between 50 to 100 mg per serving.
• Moderate: Grapes, celery, green beans, and strawberries contain about 10-50 mg per serving.
• Low: Foods such as melons, bananas, cauliflower, and avocados contain less than 10 mg per serving.

The nutritional conundrum of antinutrients

Antinutrients, including oxalates, can lead to mineral deficiencies such as deficiencies in calcium, magnesium, iron, and zinc. For example, long-term excessive intake of oxalate-rich food may decrease the bioavailability of calcium. This can impact bone and dental health if oxalate consumption remains consistently high without a balanced calcium intake.

Oxalates and Kidney Stones

For individuals with a history of kidney stones or those prone to them, oxalates can pose a particular risk. Kidney stones are commonly composed of calcium oxalate. They can be extremely painful and recurrent. They can also lead to kidney failure.

As we discussed in a previous blog, though, a great proportion of the oxalate that is excreted in the urine is actually formed by the liver from the breakdown of animal protein and collagen.

On the other hand, it is important to realize that oxalate content in the food is not as important as its bioavailability (i.e. how much of the ingested oxalate is actually getting absorbed).

A healthy and well-balanced diet containing calcium and magnesium can decrease the amount of absorbed oxalate by binding it in the gut and preventing it from getting absorbed.

Managing Antinutrients Wisely

1. Diversifying Diet: A well-diversified diet ensures a variety of nutrients and reduces the risk of excessive oxalate absorption.
2. Cooking Methods: Boiling high-oxalate foods can lead to a significant reduction in their oxalate content as a portion of the oxalate leaches into the boiling water. Thus, discarding the water after boiling foods like spinach or beet greens can help.
3. Balanced Consumption: Consuming calcium-rich foods alongside high-oxalate foods can be strategic. The oxalate and calcium can bind in the intestines, which reduces the absorption of oxalate and the risk of kidney stone formation.
4. Individualized Approach: Not everyone reacts to oxalates in the same way. Factors such as gut health, metabolic differences, and genetics play a role. For those with a history of kidney stones or other related health concerns, a more personalized approach may be needed. Consulting with an Integrative nutritionist or healthcare professional can offer insights tailored to individual health profiles.

The Role of Fiber and Nutrients

While it's crucial to emphasize once again that while is good to be aware of antinutrients, it's equally important to emphasize the positive aspects of plant-based foods. Many of these foods are rich in fiber, vitamins, and minerals that are essential for overall health. A well-balanced diet that includes a variety of nutrient-dense foods can help counteract the potential negative effects of antinutrients.

The Bottom Line

While oxalate can pose challenges in high amounts, the foods that contain it also offer various health benefits. Understanding the oxalate content in foods and strategizing their consumption can provide the benefits these foods offer without the associated risks. Embrace a holistic and informed approach to nutrition for health-empowered kidneys and life.

by Integrative Kidney

FGF-23 and Kidney Health: A Comprehensive Look at a Complex Relationship

Within the body's intricate symphony, every hormone has a role. FGF-23, or Fibroblast Growth Factor-23, is one such player. Though essential in phosphate regulation, elevated levels of FGF-23 in chronic kidney disease (CKD) have come under scrutiny. Let's explore this multifaceted molecule and understand why it becomes problematic in CKD.

By Majd Isreb, MD, FACP, FASN, IFMCP

Understanding FGF-23's Normal Function

FGF-23 is a hormone primarily produced in the bone that helps regulate phosphate and vitamin D metabolism. It maintains phosphate balance, which is essential for building strong bones, cellular function, and energy production. FGF-23 ensures that any excess phosphate gets excreted by the kidneys, thereby preventing a dangerous buildup. But the function of FGF-23 goes beyond merely regulating phosphate.

The Connection Between FGF-23 and Vitamin D

Vitamin D plays a significant role in absorbing phosphate from the diet. Its active form, 1,25-dihydroxy vitamin D, is crucial for this process. FGF-23 decreases the production of this active vitamin D form, thereby limiting phosphate absorption when needed. In turn, vitamin D can regulate FGF-23 production. This interaction ensures that both phosphate levels and FGF-23 activity are tightly controlled.

The Link Between Phosphate Intake and FGF-23

In today's world, with shifting dietary patterns and increased phosphate intake, especially through processed foods, an overload of this mineral is not uncommon. Even in the early stages of CKD, increased phosphate can push up FGF-23 levels. Managing dietary phosphate is, therefore, a critical part of controlling FGF-23 levels and slowing the progression of CKD.

Challenges in Chronic Kidney Disease (CKD)

In CKD, the kidney's ability to filter phosphate decreases, leading to an increased production of FGF-23. While this response initially helps to maintain phosphate balance, chronically elevated FGF-23 levels become problematic. High FGF-23 levels are associated with further progression of CKD and adverse cardiovascular outcomes.

In addition, the kidneys' reduced ability to convert vitamin D into its active form in CKD means that the FGF-23 and vitamin D regulatory cycle becomes disrupted. This can lead to a dangerous imbalance, making managing the disease even more complex.

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The Klotho Connection: A Key Piece of the Puzzle

Klotho, a protein closely tied to FGF-23, is often called the "anti-aging" protein. In healthy kidneys, klotho assists FGF-23 in its function. However, in CKD, klotho levels decrease, diminishing FGF-23's beneficial effects. This decline, coupled with elevated FGF23, leads to further kidney deterioration and complicates the management of CKD.

FGF-23 in CKD: The Problem with Elevation

While FGF-23's primary role is maintaining phosphate balance, its chronic elevation in CKD is concerning. The kidneys' reduced ability to filter excess phosphate leads to a compensatory rise in FGF-23. Unfortunately, this elevation can spell trouble. High levels of FGF-23 are linked to further progression of CKD and adverse cardiovascular outcomes. What starts as a protective measure turns harmful when chronically elevated.

Phosphate in the Diet: An Overlooked Factor

Increased phosphate intake, often hidden in processed foods, significantly contributes to rising FGF-23 levels. Managing dietary phosphate is vital to controlling FGF-23 levels and slowing down the progression of CKD. Awareness about food sources of phosphate and encouraging phosphate-restricted diets can make a substantial difference in managing CKD.

Navigating the FGF-23-Klotho Axis in CKD

Understanding the dynamics between FGF-23, klotho, and CKD provides insights for better management and treatment options. Innovative therapies targeting the FGF-23-klotho axis are under investigation. Interventions that control FGF-23 elevations or replenish klotho may offer improved outcomes and quality of life for CKD patients.

The Importance of Early Intervention

Identifying and addressing elevated FGF-23 levels in the early stages of CKD might be pivotal in preventing further kidney deterioration. Routine monitoring and early intervention, focusing on dietary management and possible therapeutic options, can significantly impact the course of the disease. Therefore, early restriction of dietary phosphate intake is paramount.

The Bottom Line

The relationship between FGF-23, klotho, and CKD is complex and multifaceted. FGF-23's essential function of maintaining phosphate balance can turn detrimental with chronic elevation, especially when coupled with diminishing klotho. Recognizing these interactions and emphasizing dietary management may be key to improved outcomes for CKD patients. Understanding this delicate balance opens doors to innovative therapeutic strategies that may redefine how we approach kidney health. The continuous exploration of FGF-23's role holds promise for future advancements in CKD treatment and prevention.

by Integrative Kidney

The Dual Nature of Herbs for Kidney Health: Unveiling the Benefits and Risks

When it comes to kidney health, herbs have been employed for centuries due to their medicinal properties. However, it is crucial to recognize that herbs can be a double-edged sword in this regard. While certain herbs can support kidney health, others may pose risks to the kidneys. In this blog post, we will explore the uses of herbs for kidney health, shedding light on their positive and negative impacts. By understanding this delicate balance, we can make informed choices regarding herbal remedies for kidney health.

By Majd Isreb, MD, FACP, FASN, IFMCP

Positive effects of herbs for kidney health

Dandelion root: A diuretic and antioxidant boost

Dandelion root, known for its diuretic properties, aids in the elimination of excess fluid from the body. This quality proves particularly advantageous for individuals with kidney disease, as it eases the burden on the kidneys. Furthermore, the dandelion root contains antioxidants, which shield the kidneys from free radicals that can cause damage.

Nettle leaf: Combating inflammation and fluid retention

Stinging nettle leaf, another herb celebrated for its diuretic attributes, reduces inflammation, benefiting individuals with kidney disease. Inflammation can contribute to kidney damage, making nettle leaf an excellent addition to kidney-healthy herbal regimens. Stinging nettle leaves can also be used to prevent kidney stones.

Astragalus: Renal blood flow and proteinuria improvement

Astragalus has been traditionally used in Chinese medicine for kidney health. Studies suggest that it may improve renal blood flow, reduce proteinuria (excess protein in the urine), and potentially benefit individuals with hypertensive kidney disease. However, there is a single report that showed that Astragalus membranaceus can cause increased CA19-9 and liver and kidney cysts.

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Dan Shen: Support for IgA nephropathy and renal fibrosis

Dan Shen, also known as Salvia miltiorrhiza, has shown promise in managing IgA nephropathy and Henoch-Schönlein purpura (HSP). It has been found to decrease renal fibrosis, a common complication of kidney diseases, which can help preserve kidney function.

Cordyceps Militaris: Anti-inflammatory effects and protection from toxic drugs

Cordyceps Militaris, a fungus with potential medicinal properties, has demonstrated anti-inflammatory effects in chronic kidney disease (CKD). It may also provide protection from the toxic effects of certain drugs on the kidneys and has shown promise as an adjunct therapy for managing diabetic kidney disease.

Rehmannia: Support for various kidney conditions

Rehmannia, commonly used in traditional Chinese medicine, has been found to be beneficial for chronic glomerulonephritis, lupus nephritis, diabetic kidney disease, and inflammation. It exhibits potential in managing these conditions and supporting overall kidney health.

Negative Effects of Herbs on Kidney Health

While the benefits of herbs for kidney health are noteworthy, it is important to acknowledge the potential risks associated with certain herbs. It is advisable to exercise caution when considering the following:

Ephedra: Beware of high doses

While herbs can be beneficial, certain ones can also harm the kidneys. Ephedra, commonly used as a stimulant and weight loss aid, can result in kidney damage, particularly when consumed in high doses or for prolonged periods. It has also been associated with forming kidney stones.

Licorice Root: A cautionary tale of blood pressure regulation

Licorice root contains glycyrrhizin, a compound that can induce pseudohyperaldosteronism. This condition elevates blood pressure and leads to low potassium levels in the blood. It can potentially damage the kidneys, necessitating caution in its usage. There are deglycyrrhizinated licorice products available that don't have these side effects.

Safe Use of Herbs for Kidney Health

While the benefits of herbs for kidney health are promising, it is crucial to consult healthcare professionals before incorporating them into one's routine. These experts can offer personalized guidance regarding the safe usage of herbs and identify potential interactions or risks.

The bottom line

Herbs can play a dual role in kidney health. While some herbs offer support and protection to the kidneys, others can be detrimental. Understanding this delicate balance is vital when considering herbal remedies for kidney health. Consulting healthcare professionals, using herbs in moderation, and incorporating them as part of a comprehensive approach to kidney health are key factors to remember. By doing so, individuals can harness the potential benefits of herbs while safeguarding their precious kidney health.

by Integrative Kidney

Harnessing the Anti-Inflammatory Diet for Kidney Disease Management

Living with a chronic kidney disease diagnosis can be daunting, especially when it comes with a long list of dietary restrictions. Finding a balance between these limitations and ensuring optimal nutrition can be a significant challenge. However, one nutritional approach gaining traction for its potential benefits is the anti-inflammatory diet for kidney disease.

An Overview of the Anti-Inflammatory Diet

The anti-inflammatory diet isn’t a ‘diet’ in the traditional sense - instead, it’s a lifestyle choice that emphasizes the consumption of foods known to combat inflammation and minimizes those that may provoke it. Key components of this diet include:

• Fruits and Vegetables: Packed with antioxidants, vitamins, and fiber, they are pivotal in combating inflammation. Variety is key - the more colors on your plate, the broader the nutrient spectrum.

• Whole Grains: Opt for whole grains like oats, brown rice, and quinoa. They are rich in fiber and other essential nutrients that can help keep inflammation at bay.
• Lean Protein: Limiting protein intake, in general, is helpful for kidney disease. However, that does not mean that kidney patients should become vegetarians. Choosing lean protein sources such as fish, poultry, and legumes are preferred over red and processed meats.

• Healthy Fats: Foods rich in omega-3 fatty acids, like fatty fish, avocados, nuts, and oils like olive oil, have anti-inflammatory properties.

• Spices and Herbs: Certain spices and herbs, including turmeric, ginger, rosemary, and oregano, have recognized anti-inflammatory benefits.

• Tea and Coffee: These beverages contain antioxidants and have anti-inflammatory effects. However, we recommend that coffee consumption should be based on genetic testing for genetic variations in cytochrome P450 1A2 (CYP1A2), which impacts the rate of caffeine clearance. This testing is available through many non-specialized commercially available genetic tests such as ancestry.com and 23andme.com. Slow metabolizers of caffeine should avoid drinking more than 3 cups of coffee daily.

• Conversely, it’s recommended to limit or avoid processed foods, sugary drinks, refined carbohydrates, red and processed meats, and trans fats.

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The Anti-Inflammatory Diet for Kidney Disease: A Potential Game-Changer

Chronic kidney disease often goes hand-in-hand with elevated inflammation levels. This inflammation can accelerate the progression of the disease and contribute to other complications, such as cardiovascular disease. The anti-inflammatory diet for kidney disease may help manage these symptoms by reducing inflammation, potentially slowing disease progression.

However, kidney disease patients often need to navigate specific dietary restrictions related to their condition, such as limiting potassium, phosphorus, and sodium intake. Therefore, it’s vital to collaborate with an Integrative or Functional medicine healthcare provider or a renal dietitian when planning to incorporate this diet into your lifestyle. Tailoring the diet according to each patient’s needs and type of kidney disease is crucial for success.

The bottom line

The anti-inflammatory diet, when implemented correctly, could prove to be a powerful tool in managing kidney disease. Always remember to consult with a healthcare professional before making significant dietary changes. They can provide tailored advice based on your unique nutritional needs and health status. As the saying goes, ‘Let food be thy medicine,’ and let this diet be a step towards better kidney health.

by Integrative Kidney

Boost Kidney Health with Glutathione: Exploring Selenium, Oxidative Stress, and Ferroptosis

Understanding the role of glutathione, the master antioxidant, is key to ensuring kidney health. One of the leading lines of defense in our body against oxidative stress and ferroptosis, glutathione plays a pivotal role in keeping our kidneys in optimal health. This blog post will delve into the connection between selenium and glutathione, the damaging effects of oxidative stress and ferroptosis on kidney health, and how we can support our body’s glutathione levels, including the use of liposomal glutathione.

Selenium: A Key Player in Glutathione Levels

The trace mineral selenium is an integral part of the enzyme glutathione peroxidase (GPx), which is central to our body’s antioxidant defense mechanism. GPx combats oxidative damage by neutralizing harmful reactive oxygen species (ROS). ROS are highly reactive, unstable molecules our bodies produce during normal metabolism and in response to environmental stresses. They can cause damage to cells if they aren't properly controlled by our natural antioxidant systems. Keeping a balanced selenium intake is essential to maintain healthy glutathione levels, which is crucial for robust kidney health. To read more about the role of selenium in protecting the kidneys from oxidative stress, read this blog.

How Oxidative Stress Affects Your Kidneys

When ROS production surpasses your body’s capacity to neutralize them, oxidative stress occurs. This condition leads to inflammation, cellular damage, and, in extreme cases, cell death. Kidneys are especially prone to oxidative stress due to their high energy needs and robust blood supply. Over time, oxidative stress can cause kidney damage, and worsen existing conditions, leading to fibrosis (scarring). This will lead to faster progression of chronic kidney disease (CKD).

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Ferroptosis: An Emerging Concern for Kidney Health

Ferroptosis is a newly identified form of regulated cell death distinguished by iron accumulation which leads to increased ROS. ROS then interacts with lipids in the cell membranes causing cellular death. It has significant implications for various health conditions, including kidney damage. Glutathione aids in preventing ferroptosis by neutralizing ROS and sustaining the function of the GPx4 enzyme, thereby protecting cells from lipid peroxidation. You can read more about it here.

Bolstering Glutathione Levels for Optimal Kidney Health

You can see now that supporting glutathione is crucial for better kidney health. Here are some ways to boost the body’s glutathione levels:

1. Selenium supplementation: Ensuring proper selenium intake can support glutathione levels and fortify kidney health. Brazil nuts, fish, and whole grains are excellent dietary sources of selenium. Patients with kidney disease should aim for 200 mcg of selenium daily, either through high-quality supplements or diet. This can be easily accomplished by eating only two Brazil nuts a day.
2. N-acetylcysteine (NAC): NAC is a glutathione precursor that can enhance its levels in the body. Studies suggest that NAC supplementation can positively affect kidney function in CKD patients. There isn't a standard dose for NAC, but clinical studies for various conditions have used doses ranging from 600 to 1800 milligrams per day, typically divided into 2 or 3 doses. We use Pure Encapsulation NAC 600 mg capsules at a dose of 1200 mg twice a day. However, it's essential to start with a lower dose to assess tolerance and consult an Integrative or Functional medicine-certified provider.
3. Liposomal glutathione: Liposomal glutathione, a form of glutathione encapsulated in liposomes for improved absorption, may be more effective in boosting glutathione levels than other forms, according to some studies. This study showed that doses of 500-1000 mg were sufficient to reduce markers of oxidative stress. However, it's best to follow the manufacturer's instructions and consult an Integrative or Functional medicine healthcare provider
4. Antioxidant-rich diet: Food is medicine. Consuming a diet abundant in fruits, vegetables, and whole grains can provide various antioxidants that support glutathione levels and overall kidney health.

The bottom line

Boosting glutathione levels is key to maintaining kidney health. Understanding the roles of selenium, oxidative stress, and ferroptosis allows us to take active steps in protecting our kidneys. By supplementing with selenium, NAC, or liposomal glutathione and adopting a diet rich in antioxidants, we can ensure optimal glutathione levels for overall kidney health.

by Integrative Kidney