Functional Nephrology
Manpreet Samra, M.D. and Certified Functional Medicine Practitioner
Articles, blogs and links
Sleep and Chronic Kidney Disease
The quality of one's sleep has been associated with a plethora of health conditions. Now, one can add chronic kidney disease to that list thanks to researchers in Korea.
A study by the researchers at the Sungkyunkwan University School of Medicine in Seoul, Korea discovered a correlation between eGFR levels and quality of sleep.
The researchers defined and divided quality of sleep into three categories: under sleepers (less than 6 hours), optimal (6-8 hours) and over sleepers (more than 8).
Both eGFR and 24 hour urine protein levels showed the best results for those who consistently slept an optimal amount. In turn, researchers deduced that one's quality of life is better with an optimal amount of sleep when battling chronic kidney disease.
Note, this study focused solely on pre-dialysis patients diagnosed with chronic kidney disease.
Please feel free to contact me if you are interested in a sleep consult in an effort to improve your battle against chronic kidney disease.
By: Manpreet Samra, M.D. and certified Functional Medicine practitioner; 5.14.18.
Diagnosing CKD and Diabetes
It is well understood that diabetes acts a precursor to chronic kidney disease. Therefore, a diabetes diagnosis serves as a warning sign that one is at risk for kidney disease.
A new study shines more light on this but with a twist.
This study, which studied veterans at a VA over the course of 10 years, found a diagnosis of diabetes in 30% of its patients after a chronic kidney disease diagnosis.
This is troubling because chronic kidney disease is a silent disease meaning it doesn't present noticeable symptoms that one would raise to his or her primary care physician. Rather, doctors rely on routine screenings and other risk factors, like diabetes, to look for kidney disease.
In this case, the risk factor of diabetes, wasn't detected until after a doctor diagnosed chronic kidney disease in approximately 30% of the patients studied.
The takeaway from this study is proper and timely screening. If one is at risk for diabetes, even before any blood tests indicate diabetes, one should increase his or her frequency of screenings and adopt a functional medicine approach to diabetes to ward off chronic kidney disease. Particularly susceptible groups of populations are older people, those who possess hemoglobin A1C, high blood pressure and high BMI.
I am available for phone consultations related to managing diabetes and chronic kidney disease through functional medicine.
By: Manpreet Samra, M.D. and certified Functional Medicine practitioner; 3.16.18.
Kidney Disease and Hypertension
One of the most common causes of kidney disease is high blood pressure. High blood pressure, also known as hypertension, affects an important network of blood vessels called nephrons that filter waste from blood. These blood vessels narrow, stiffen or clog impairing the filtering process of the kidneys.
The logic behind studying and addressing high blood pressure to treat kidney disease is clear. However, the manner in which high blood pressure is primarily treated can differ.
There are a plethora of medications that tout effective treatment of high blood pressure. I wouldn’t be surprised if anyone reading this who’s been diagnosed with high blood pressure has been prescribed one.
There’s another mode of treatment that languishes in the background without a strong doctor advocate and patient compliance: addressing the root cause of high blood pressure.
This entails diet and lifestyle modifications in the form of daily exercise, natural foods low in sugar and sodium and high in fiber, an age/gender appropriate body mass index, yoga, meditation and not smoking.
Digging deeper, one’s genetics, nutritional intake levels, environment and habits should be analyzed. For example, an elevated mercury level, hormonal imbalance, systematic inflammation or elevated sugar levels may contribute to one’s hypertension.
The more one can narrow down the root cause, the more likely one is to be excited and engaged to address the cause.
The general proverb of eating right and exercising is like treating your neighbors the way you want to be treated: it’s easier said than done.
However, knowledge of a cause and a targeted response can break through the monotone drab of diet and exercise.
By: Manpreet Samra, M.D. and certified Functional Medicine practitioner; 2.9.18.
Belittle to Embolden
I recently came across an article that harkens too an oft too-common method of proving a point I term "belittling to embolden."
It goes like this. In order to increase the attraction or value of something one deems important, one belittles or diminishes what appears to be a competitor. Time and time again, such an approach misses the point and misses the mark as far as helping people.
The article I referenced in my first paragraph came from a standpoint of attacking traditional medicine while extolling the benefits of functional medicine. A persuadable or vulnerable person could easily consider making a clean substitute: traditional medicine for functional medicine.
That's not what I believe.
It would behoove the well being of a patient to turn one's back on either approach in its totality depending on the condition at issue. More often than not, one's best health outcome requires a merging of traditional and functional medicine (including a smooth chain of communication between your respective practitioners).
Agendas infect more than we can smell out. It's true in every component of our society. Medicine and the different approaches to it are no different.
By: Manpreet Samra, M.D. and certified Functional Medicine practitioner; 1.12.18.
The Lion of One's Plant Based Diet: Lentils
It's bantered around what seems like ceaselessly when one's dealing with a chronic disease like kidney disease: the adoption of a plant based diet. You may have found yourself nodding in agreement when your doctor advises it or have taken a mental note after reading the benefits of it online. However, implementing this can prove difficult for a multitude of reasons.
A good starting point to overcoming these hurdles is simplifying the transition by focusing on a single food: lentils.
Lentils, deriving from the Legume family, have existed and been eaten by humans since pre-historic times with lentil seeds discovered in the Middle East from 8,000 years ago.
Lentils are an excellent source of molybdenum, folate, dietary fiber, copper, phosphorus, manganese, iron, protein, vitamin B1, pantothenic acid, zinc, potassium and vitamin B6.
Lentils are available at grocery stores as seeds or pre-packaged. Both forms contain almost the same amount of nutrition.
The benefits are numerous: fiber, cardiovascular benefits due to the folate and magnesium, stabilized blood sugar levels while providing a steady rate of energy, and iron.
Lentils can be added to a number of other foods like brown rice, a salad or into a soup.
The key, even if you choose a different plant based protein other than lentils, is to start the transition to a plant based diet. Do not abandon this plan if a wholesale change has proven or seems too difficult. Start with a single food and build off that. Rome wasn't built in a day. Transitioning from an animal based diet to a plant based diet won't either so don't get down if it takes time. You will get there.
By: Manpreet Samra, M.D. and certified Functional Medicine practitioner; 11.5.17
The Escape Route
It happens time and time again. You're at a restaurant, at a house party or traveling. The prospects of finding a meal that doesn't send your diet goals into a tailspin looks bleak. The restaurant uses too much oil and butter. The house party is snacks only. The road is littered with fast food restaurants.
What should one do in this case?
Mitigate.
One, accept that you have to eat something. Skipping a meal isn't aiding any of your goals. Two, find anything that is green and load up on it. Lettuce, spinach, kale etc. Avoid dressing and cheese if your chosen mode of greens delivery is a salad. Three, drink lots of water. Four, find the leanest meat like grilled chicken or beans and green peas. It's definitely not your ideal meal but sometimes life requires improvisation, adaptability and holding onto the proverbial rope.
By: Manpreet Samra, M.D. and certified Functional Medicine practitioner; 10.16.17
Pain, Veterans and Functional Medicine
A recent study revealed promising results from the implementation of certain Functional Medicine tenets in a subset of the general population, United States Military Veterans.
The Functional Medicine practitioners focused on teaching diet, nutrition, exercise, stress management and sleep hygiene during four sessions of sixty to seventy-five minutes to Veterans experiencing pain.
The Veterans completed a Medical Symptoms Questionnaire, Perceived Stress Scale and Insomnia Severity Index upon their first and last session.
Dr. David Cosio, lead investigator of this study, concluded that a four session Functional Medicine clinic led to a decrease in perceived stress and joint/muscle symptoms. In addition, the Functional Medicine approach reinforced the self-management approach to chronic pain management.
By: Manpreet Samra, M.D. and certified Functional Medicine practitioner; 9.21.17
The Soaring Cost of Insulin
Diabetes seems like an unlikely contributing factor to kidney disease. However, study after study has shown that diabetes is, in fact, a major factor in kidney disease.
Diabetes affects the kidneys in one of two ways. One, diabetes damages blood vessels including inside one's kidneys. This results in a negative impact on the functionality of one's kidneys. Two, diabetes may cause nerve damage which, again, results in a negative impact on the functionality of one's kidneys.
There is no question treating diabetes and the underlying basis for diabetes will have a positive impact on one's kidney disease.
Unfortunately, the cost of insulin has risen to the point that some individuals who need a daily dose of insulin are rationing their intake to avoid the costly refills and high deductibles. For example, one popular type of insulin increased in price from $44 to $300 from 2001 - 2014.
The real solution and more cost effective solution is treating the underlying basis of diabetes: largely one's diet. There are certain simple (but not easy to comply with) changes one can make such as eliminating refined sugar. Ultimately, this can not only slow or reverse the progression of one's diabetes but also kidney disease.
By: Manpreet Samra, M.D. and certified Functional Medicine practitioner; 9.11.17
The Bi-Directional Dilemma
A recent study found a bi-directional impact of depression and obesity. Researchers refer to a bi-directional impact, in this context, of obesity increasing the odds of being depressed and vice versa.
The results aren't surprising and aren't likely limited to obesity and depression. A similar bidirectional affect can be seen in some people diagnosed with kidney disease and obesity. The common element in this the underlying factor in obesity - one's lifestyle and nutrition. In the case of kidney disease, one's lifestyle and nutrition can do one of three things: hasten, act neutrally or slow the progression of kidney disease.
What's apparent is the bi-directional impact and extrapolating the tri-directional impact of diseases makes it clear that the underlying cause of one's disease needs to be addressed to successfully treat the primary disease. The more often this is done, the more often the person suffering from the disease will be placed in his or her best position to successfully ward off or slow the progression of their kidney disease.
By: Manpreet Samra, M.D. and certified Functional Medicine practitioner; 8.11.17
The Five Root Causes of Diseases
The power and success of Functional Medicine is often seen through the lens of the end result: a marked improvement in how you feel and the halting of the progression of one's disease or diseases. It's difficult not to see it from this perspective. It's why Functional Medicine exists: to make you better.
It's ironic that the utilization of Functional Medicine leads to that end-result perspective. Functional Medicine, itself, searches for the root causes of diseases. It looks at the beginning or origin of the disease - not the end result.
This analysis has lead to a discovery of the five most common root causes of diseases: (1) toxins (2) stress (3) allergens (4) poor diet and (5) microbes.
A Functional Medicine approach to kidney disease is no different.
My expertise lies in analyzing these root causes within the prism of your particular kidney disease while crafting a specialized and unique plan to help you understand and battle these root causes. It's an exciting chapter in treating chronic kidney disease in the 21st century and one I'm happy to be at the forefront of.
By: Manpreet Samra, M.D. and certified Functional Medicine practitioner; 8.7.17
Yes to Yoga!
Yearning for yoga? Have those words never left your lips?
You’re not alone. The fear of trying a new exercise in a group setting can send chills up the least self-conscious person. But this is no gimmick hiding behind a veneer of unattainable and ill-purposed goals like rapid weight loss.
Yoga is 4,500 years old. It’s more relevant today than at any other time in history. The principles that form the foundation of Yoga have been developed over a lengthy course of trial, error and success.
There have been countless anecdotal reports of Yoga affecting chronic diseases over the past century with the advent of modernized western medicine. Now, more formal, peer-reviewed studies are being published showcasing the beneficial effects of Yoga. Specifically, in the realm of those fighting chronic disease and the improvement of immune functions. For example, one study showed a decrease in distress and an increase in functional performance. Another study showed a positive effect on immunological indicators. This complements the more well-known benefits like improved cardiovascular health, respiration and increased muscle strength.
We encourage you to start your Yoga journey today if you’re suffering from kidney disease. As always with a new exercise, start in moderation and build according to your physical abilities. Community centers or community fitness centers are a fantastic place to start as they are sure to have beginner courses. Yoga studios will also offer beginner level classes but may be more expensive. Most Yoga studios will offer a reduced introductory rate for first time students. Please contact us if you need assistance locating the right location and class.
By: Manpreet Samra, M.D. and certified Functional Medicine practitioner; 7.24.17
Conventional medicine vs. Functional medicine
Why I believe in Functional Medicine in the treatment of Kidney Disease
Spotting issues. We do it everyday. It helps us foresee and prepare for what lies ahead.
Sometimes, we get it wrong and it has nothing to do with effort. Sometimes, we're approaching the problem with a faulty or weak analytical process.
For example, can you spot the fault in my title to this post? It stems from a faulty analysis. It's the way I framed the title as a competition, a battle royale, between conventional medicine and Functional Medicine. This isn't Monday Night Football. This isn't partisan politics. One is not mutually exclusive of the other.
Yet, medical professionals have been trained (I know because I'm one of them) to spot symptoms and to treat those symptoms. There's no question this works well as westernized medicine has prolonged life expectancy and is at the forefront of medical breakthroughs.
But what works better than well in terms of health? Life altering.
Functional Medicine attempts to accomplish this by changing how we spot issues. Instead of focusing almost exclusively on symptoms, Functional Medicine focuses on the root causes of one's symptoms. This involves an analysis of one's personalized and therefore unique standing in this world: his or her environmental exposure, genetic history/predispositions and lifestyle including critically diet.
This type of analysis Functional Medicine advocates, in conjunction with conventional medicine, is where the rubber meets the road in placing yourself in the best position to battle and defeat a disease.
By: Manpreet Samra, M.D. and certified Functional Medicine practitioner; 7.20.17.
The optics may seem incompatible. Conventional medicine vs. Functional Medicine. Disease centered diagnosis and treatment vs. patient centered diagnosis and analysis.
The truth is the best conventional medicine incorporates Functional Medicine. What's even more true is for a host of reasons a medical doctor simply cannot merge the two due to external constraints such as time, insurance and expertise limitations. This doesn't mean your doctor and my colleagues are at fault. It's the reality of modern medicine in the United States.
Despite this reality, there was something I could do if I truly believed in it: I could bring the tenets of Functional Medicine to those patients afflicted with a disease that is my expertise, kidney disease.
I set out to explore Functional Medicine in 2014 as I practiced as a general Nephrologist in the greater Cleveland, Ohio area. I immediately appreciated the sensitivities to one's environment, genetic history, diet and lifestyle in evaluating a patient. Not only did I begin to spend more time with my patients discussing and drafting a game plan for them based on these tenets but I also incorporated the dietary changes to my own diet. I witnessed astounding improvements in kidney function among patients who most adhered to my Functional Medicine based plan. The satisfaction I felt and the pure bliss these patients experienced by, in some cases, avoiding dialysis was enough for me to seek a certification in Functional Medicine. I believed in Functional Medicine.
I began attending conferences, seminars and classes offered by the Institute of Functional Medicine over the next three years. In 2017, I officially became a certified Functional Medicine practitioner after completing and successfully passing a certification exam issued by the Institute of Functional Medicine. In between, I've continued my growth as a kidney specialist in traditional medicine by completing a kidney transplant fellowship at the University of Chicago.
All of this has resulted in one thing: to help you in your battle against kidney disease by incorporating Functional Medicine.
In conjunction with your team of medical doctors, I will put you in the best position to successfully battle and beat kidney disease.
By: Manpreet Samra, M.D. and certified Functional Medicine practitioner; 7.18.17