Protect Your Kidneys, Transform Your Health: A Deep Dive with Dr. Neetu Sharma

So welcome, synergy listeners. Today we have an extraordinary guest who is revolutionizing the way we think about kidney health and chronic disease prevention. Meet Dr. Neetu Sharma, also known as the Kidney Whisperer, a double board certified kidney specialist and functional medicine expert on a mission to tackle chronic disease at its root cause. With over 15 years of experience, Dr. Sharma is redefining healthcare by combining nephrology with holistic and functional medicine, helping patients take control of their health before disease takes control of them. She's the founder of Zeal Vitality, an innovative virtual healthcare platform that goes beyond symptom management, using biomarker analysis and genomic testing to craft personalized wellness plans. But for Dr. Sharma, this work is deeply personal. Having seen family members endure dialysis, she is passionate about prevention over intervention, especially for midlife professionals facing metabolic challenges. She believes in turning patients into active participants in their healing journey, making sustainable lifestyle changes that protect kidney function and optimize overall health. Dr. Sharma's unique blend of medical expertise and heartfelt storytelling will leave you informed, inspired, and empowered to take charge of your well being. So sit back, tune in, and let's get started with Dr. Neetu Sharma.

We are so excited, Dr. Sharma, that you are here. I feel like we found a treasure when your bio came across, because this is something Lori and I have really been digging into. Lori's been into the metabolic medicine for many, many years. And I've just kind of transitioned from hormone thinking to, okay, what's chronic disease thinking?

Right.

Because we know we're seeing a lot of dysmetabolic people show up wanting hormones, but underneath that current of hormone dysregulation, we have all this metabolic dysfunction going on. So we're so glad you're here so to talk more about that and to learn really that intersection between overall health and kidney health. So thank you for being here.

Thank you so much for inviting me over.

So we have to always ask the story, right? I mean, I think that all of us in this functional medicine space, we have our own story that got us here looking at health through a different lens. So what is that for you?

Growing up, I always knew that I wanted to become a doctor. And. And in India, the education was the priority for Indian family. And growing up there, my parents made sure that I am well educated and I pursue my passion of becoming a doctor. Then one of my uncle fell. You know, he had high blood pressure and diabetes and he started developing kidney issues and ended up on dialysis. And that kind of sparked the curiosity into nephrology. World. So I pursued my nephrology fellowship here in University of Cincinnati and I have been in practice for over 15 years. So I have seen these patients with kidney problems and they are very complex patients dealing with high blood pressure, cardiomyopathy, heart disease with diabetes, and lot of other problems coming in with the kidney issues. And many of them eventually, over the period of time ended up on dialysis. When the pandemic hit, I lost a lot of dialysis patients and lot of chronic kidney patients because these are the patients who are very fragile and they are dealing with a lot of health issues. And that kind of was a very eye opening period for me. Another family member, my mother in law, went through dialysis and eventually passed away. So I've seen that very closely that how the chronic diseases dialysis put a toll not only for the patients, but also for the families. And it just alters your whole lifestyle and your life just revolves around dialysis, going to the doct, getting the prescriptions, and that's what I was doing. And in my conventional medicine, you know, the expectation is that you spend 10 minutes with patients and give them medications and just, you know, be on the autopilot mode all day. And I found myself gaining weight during the pandemic. I found myself, you know, not feeling well, low energy, brain fog, all those issues which I'm treating patients with, I started having in my own life and I'm like, you know, my labs are normal, I look okay, but there is something wrong and I have to do something about it. And I was listening to Mark Hyman for the longest time and I started looking into functional medicine world. So did my functional medicine fellowship with IFM and gained a lot of insight and started applying those principles not only on myself and my family, but also on my patients. And then I saw great results. You know, I lost a lot of weight, my husband lost a lot of weight. You know, we reversed our cholesterol and I'm feeling more energetic, I'm feeling more, you know, full of life. So that's the result I'm seeing in my patients too, with the metabolic reversal. And here I am, you know, I founded Zeal Vitality last year to help patients with the virtual care, including the functional medicine and conventional medicine principles, and launch few programs and just trying to help the general population.

I love it. So I just have to ask, you know, in the space of conventional medicine, and maybe even in the spatial space of functional medicine, you go in for your yearly exam, you get a metabolic panel and you know, your numbers aren't necessarily ideal, but they're okay. And we're just patted on the head and said, we'll see you next year. Like what are we missing? Because I feel like even in that just basic metabolic panel, there are signs of trouble ahead that are being ignored until we do have a major challenge and dialysis has to be the, the final answer. So what would you say to that? What are the trends that we should be looking out for for patient? You know what, when the patient goes and gets their labs, what should they be looking at?

This is the most important question you're asking. What are we missing? Right. In our day to day life, like when we are practicing medicine, this is how we are trained. And over the period of time when the pressure, corporate pressure is there, the practice pressure is there, the goal is to just take, you know, take care of the patients, give them prescriptions and let them go. But nobody is really talking about what is the root cause of all these problems and why they are keep coming back, why they are actually getting worse rather than getting better with all these medications. So the metabolic panel, which we are ordering as a conventional practitioners in our clinics are very, very basic panel. It tells you about your lab work when the things are already worse, right? So the kidney patients who were coming to me, they are already in stage three, stage four, even stage five of kidney disease, which is like the highest level of kidney disease. And after that is the dialysis. So looking at those, those panels really is not going to tell you much about what's going on underneath, right? So like in my case also when I was having normal lab work, but I wasn't feeling good, that means that my cellular level, at my mitochondrial level, something is going on in my body which is giving me those early signals. But I' finding it on the labs. So you know, in, in the, when you go to your doctor's office, they check your weight, they check your blood pressure, hemoglobin A1c and cholesterol. But, but these are again very basic panels and they don't tell the whole picture of what's going on. And in functional testing we look at like if your cholesterol is high, what kind of cholesterol is high, right? There are, we know now there is oxidized ldh, there is different kinds of ldh and depending on what level is high, will put you at higher risk of cardiovascular disease. Similarly, in precision medicine, we are utilizing the biomarkers where we are looking at the early signs of kidney disease in the form of interleukin 18. We are looking at the kidney injury molecule 1 and, you know, along with the creatinine and B1, which is usually what the doctors look at in their panel. So we are looking beyond that to have the early diagnosis and, you know, prevention of the disease is the key here. So once we know that there is something going on at the cellular level, then we can, you know, give them the protocols to reverse it before even the disease occur. And that's the approach I'm taking now.

So what, what constitutes the diagnosis of stage three?

Yeah. So, you know, we have five of chronic kidney disease.

Right.

And stage one is actually not really a kidney disease. Everybody has, you know, kidney function of 100 or more. Stage one is when your GFR, which is the filtration rate which we see on the blood work, more than 90%. And when it's between 60 to 90%, that's stage two. And stage two is the early sign of kidney damage. And if we don't do anything in that stage, it usually progress to stage three, stage four and stage five. So stage three is between 30% and 60%.

Okay.

And stage four is 15 to 30%.

I think that's important. Yeah. For our listeners to know, because that's something they're getting every year. And I do. It's not flagged until they're stage three.

Well, and there's that difference between reference range and optimal range. And that's what I just heard Dr. Sharma say, that, you know, until you reach the threshold outside of reference range. Right. Which is sick people going to the lab to have this done. Right. With the bell curve. You're outside of that bell curve. Then you now, oh, I have a problem. When the reality is, is the red, the writings on the wall long before that. And in traditional labs, if you're only looking at the reference range, you're missing it. And it's my understanding too, when looking at, you know, certain levels like gfr, more integrative functional medicine specialists are looking beyond that, even into cystatin C, in a different way of looking at kidney stress. So GFR on a basic metabolic panel really isn't the greatest test either. Is that so, or how do you feel about that?

So GFR actually gives you a good picture of where your kidney function stands in percentage wise. But of course, it varies depending on your condition, your environment. And same thing with the creatinine and bun. So if you're eating a lot of protein and that's going to produce more, more byproducts, your creatinine and BUN is going to be higher. If you are also having dehydration, that will decrease your gfr, that will increase your creatinine. And those could be the temporary reasons for the fluctuation. And there are various, you know, testing which we do for the GFR also, there are different calculations which are out there, and different labs will have different reference range. So it just gives you the whole. It doesn't give you the whole picture, but just the ballpark of where your kidney function lies. But of course, cystatin C is very good marker. We use Interleukin 18 and Kim 1, as I mentioned, and Gal, all those things can tell you more about your kidneys even before you see that your BUN and creatinine is out of that normal range.

And I love that Cleveland panels and a lot of the more advanced functional integrative, they're, you know, they've been offering cystatin C in its calculation with GFR for quite some time. I feel like it was more popularized going through, going through Covid and after, because we began looking at, you know, cystatin C kidney function, as well as Galectin 3 in reference to NBNP, in reference to heart function and volume overload. Right. As well as infection.

Yeah, yeah, yeah. Because the statin C is produced by all the. All the cells in the body. Right. So it's not specific for the kidney, but it tells you a lot what's going on in your body as far as the vital organs are concerned. And same thing with the engal. But the KIM, which is the kidney injury molecule 1, is particularly increased in acute kidney injury when you have proximal tubular damage. It's the specific part of the kid kidney which is damaged, and that can cause that specific marker to increase. So there are specific biomarker which we can look at, but the sustainancy and gal will give you the overall picture too.

I think we can all agree that the basic labs that we were taught and we utilized in a season, Right. They were what we needed them to be, but we've advanced well beyond that. And we have so much now that we have access to. And the unfortunate part is that many professionals, many physicians, nurse practitioners, licensed professionals that are treating in traditional medicine are not utilizing them. And I don't know how sad you that you find that, but we find that incredibly sad.

Yeah, yeah. So, you know, I actually, that was my frustration because my patients were not getting better. They were actually getting sicker day by day, no matter what I was doing. There is so much advancement as you Said there are new medications which came on market. You know, nowadays we are using Farsiga India to help with the kidney patients. And in spite of giving those medications, we have seen that patients were declining. And that's the sad part of it, because these patients were complex and they were. Their heart was getting affected, their blood pressure was off, they were on four, five plus medications, and they were not getting better. So that's why I chose this path of functional medicine, so that I can help them more with the more elaborated lab work is very important to tell the root cause of the disease, and then we can tackle the root cause and help prevent that disease to occur.

So what I'm hearing you say is in conventional medicine, despite all the medications you have and despite the fancy testing that you perhaps could order, the tools in your toolbox weren't there. You didn't have the other things to walk someone through lifestyle change and probably not the time to teach them the things that they needed to know in order to walk themselves back to a place of health. Is that fair to say?

Yeah, that is true. Because, you know, in traditional medicine, the collaboration is very important. So although we had dietitian, we could refer our patients to, to be on a renal diet or on a diet which is, you know, more appropriate for their heart function and high blood pressure, more than that, you know, they need the whole lifestyle change, the dietary plan, and some people, they need more hand holding, more counseling. And then we were lacking that time and resources in the traditional medicine, and I don't think the physicians are inclined towards it. And again, it's because of the, you know, it's not the lack of knowledge, but I think it's the lack of initiative in that direction because it takes more infrastructure, it takes more commitment and investments to have all that collaboration and different, you know, health coaches to be involved in the practice to help those patients. So that's what we were lacking.

Yes, yep.

And.

And what you're saying is that the insurance model, right, is limited in its capacity to do that. Right. Because it's not.

It's.

It's.

It's not paid for. And the investment, I love that word, investment, we use that all the time because it truly is an investment of time, money and resources for both the practitioners that make this choice to make this shift and change. And so, you know, kudos to you for doing that, because that's not an easy shift. We could be passionate, but there's a lot of expense, if you will, in that transition. But recognizing that it's an investment not just for us as providers of care, but it is absolutely an investment for each and every one of the clients, patients, whatever you choose to call them, who choose to come alongside and be coached by you.

That is true. But at least I can sleep peacefully at night. I am very conscious about my work and if I can make a difference in anybody's life, that will give me immense satisfaction.

Absolutely. That is the reward. That is absolutely the reward. And hence the reason we were so excited to talk to you, because we, we are, you know, as pioneers and people that are out there every day trying to get this message out. It, it can feel like sometimes we are an island. Right. We're fighting the good fight. And so to find other people equally as passionate and who truly desire to see true change and people and are investing, it's, it's really, it warms my heart.

Yes, that is true. And I met only two functional nephrologists so far in the past one year, which is a good thing. At least. I'm seeing more physicians coming up. I had recent talk with the cardiologist who also is embarked on the functional medicine and precision medicine pathway. So, you know, the unicorns are out there, but they are getting more and more common. Yes.

And I was going to ask you that question is, you know, how are you perceived among your peers? Whether we like it or not? Right. You know, it's, you know, sometimes we have to get to the point in which we really, you know, we, we know that pioneers are not necessarily going to be liked or accepted. Right. We've, we, we know that. But how are you accepted amongst your peers in nephrology? What kind of feedback do you get?

You know, some people, they encourage and they, they are actually surprised by the choice of path I have taken because, you know, when you start something new, you have to start from scratch. And as you said that you feel like you're on island. So I really didn't have much of the collaboration with other nephrologists who are practicing in traditional medicine. They continue to work like they are doing now, but I decided that I have to make some change for myself and for the patients I'm serving. Yeah, so it's, it's like taken. Some people take it positively. Some people, you know, give me some eye. But that is okay. That's okay.

Congratulations in being different. We, we do appreciate that. So what is the link? And, and when, when is, and when does kidney disease start?

Kidney disease is getting more and more common because it's associated with the diabetes. So one in three people with diabetes, they have kidney disease and about 50% of them end up on end stage renal disease, which is like ending up on dialysis. So, you know, having diabetes, high blood pressure, obesity, metabolic dysfunction, that's how everything starts. And by the time we come to know about the kidney disease in the lab, it's already too late. So the question is, when do the kidney disease start?

Yeah, right.

Like I think that's, yeah, it's, it's usually linked with your age. Also, after 40, 50 years of age, you will start losing your GFI at some pace. But if it is, if you're losing your GFR more than three or four points in a year, that tells you that it is the early sign of loss of kidney function and you have to do something drastically to reverse it.

How does hydration, how does hydration play a role in that?

Yeah, hydration plays a very big role because I have seen patients who are dehydrated coming in with acute kidney injury. But the good news is that it's completely reversible if you hydrate those patients. And there is no other factor which is involved with the kidney injury at that point. So you have probably seen it in marathon runners or people who are not drinking enough water. I had a patient who was just drinking pop all the time, was not a water person. She came in with kidney problems at the age of 60 and I just told her to just give up her pop and start drinking water water. Three months later her kidney function was normal.

So for our listeners that are going in to have their metabolic panel assessed, what's the amount of water they should have the morning before their blood draw? Like how hydrated should they be in order to have consistency of testing over time? So what is your rule of thumb on hydration prior to testing the amount.

Of water your body needs? Usually if you say generalized tome is six to eight glasses a day, but it varies depending on your condition. So if you are a laborer who is working outdoors in summer and sweating a lot, or you are an athlete who is participating in different sports and hot day, you probably would need 12 glasses of water. Right. So it's not a generalized thing for everybody, but, but usually whenever you are thirsty, drink water over the over the day. I am not recommending drinking gul gallons of water because water intoxication is also real. But six to eight glasses in general is what we recommend. Keep yourself hydrated. If you start noticing that your urine is getting more darker, that means you are under hydrated. So that is another sign you can look for, if you are looking that your skin is more saggy, it's not pulp, and your mouth is dry. Those are the early signs that. That your body is telling you you have to drink more water.

Yeah. And then what about diet? You have mentioned it, Lori has mentioned it, but we really haven't gotten into it. Like, what is your stance? Lori and I both believe food first for healing and repair. But what does that look like for someone with renal concerns?

Diet plays a very important role in kidney patients, early stages of kidney disease. You know, if you have a GFR of more than 35, 40, you really don't need to make much adjustment in your diet. But GFR starts declining less than 35. I usually put patients on low protein diet, which means about 0.8 grams of per kilograms of protein you have to take according to your body weight. So that is important because high protein causes the increase in the byproducts in the blood, and that is all the waste which is cleared by your kidneys. And when kidneys are sluggish that we start accumulating in your blood, your bun will increase. And that urea can cause confusion. It can cause more side effects in terms of, you know, electrolyte imbalances, more swelling in your legs, around your eyes. So it is very important to keep your protein in the diet low. And then you have to be mindful about not taking too much off of potassium in your diet, because that is also the major electrolyte which is excreted in our urine by the kidneys. So if you are eating a lot of bananas, oranges, tomatoes, avocados, potatoes, they are all full of potassium. So we tell our patients not to eat that much of potassium. Phosphorus is another culprit. So dairy and cheeses, they have very high phosphorus, including the puppy. So those are the things we need to avoid in kidney patients. So in general, I always like, not particularly in kidney patients, but for everybody, high diet, which is rich in the antioxidants and omega 3 lean protein. Those are the recommendations I have.

Yeah.

So for general prevention, it's more of a balanced diet that includes the animal protein. But when we start getting into stage three and beyond, we have to restrict protein and really watch potassium. Is that what I'm hearing?

That is true. Especially the keto diet, which is high in protein. That is not recommended for kidney patients. I'm okay with DASH diet because it will help with the, with the blood pressure, and I'm okay with the Mediterranean diet. So. But in kidney patients, we have to, when the GFR starts declining less than 35. We have to be mindful about the proteins, potassium and phosphorus.

Yes. Which I believe is stage four. Right. Yes. I just wanted to reiterate that because it's not stage three, it's stage four. Right.

Okay.

So because stage one, two and three, we really do want to have a well balanced diet. Right. Whole food farm to plate, obviously non GMO and toxin and pesticide free, all of that good stuff. Right. We certainly don't want a lot of carbohydrates. We want balanced carbohydrates, more of the fiber. And I hear you saying that we really do need to have quality protein in. Once we start getting. I think this is what I heard you say. Once we start getting to where that those kidneys are really having a harder time in that 35 or less range, we do have to kind of look at that 0.8. That's still a reasonable amount.

Still a reasonable amount of protein.

Yeah, exactly. Because I think a lot of people don't even know what that equates to. You know, we're just in the standard American diet of so many carbohydrates and so little carbs. You ask a person, how many grams of protein do you eat? They're like grams.

What is, what is that?

Yeah, yeah, that is true. Yeah. I mean 0.8 grams of protein per kilogram of your weight here we look more in the pounds, but that's kind of general idea. Which gives you about the protein consumption in those patients. Yeah, right.

And are you speaking mostly to the adjusted EGFR based on cystatin C? Are you talking about the GFR on a bmp? Because there can be a lot of disparity between those two numbers, as I have seen.

That is true. It depends on the lab where you are patients too, and different labs, they follow different criterias. There might be a disparity, like with 5 to even 5 to 10 points I have seen. So it's always a good idea if you are seeing your GFR declining a little bit on the labs. Just keep yourself hydrated, be mindful about what you're eating and repeat those labs again.

And I would imagine over the counter medications as well. What's the most common things that you see in the way of over the counter products that are destructive to the kidneys?

Thank you for asking that question. Because you know, many patients, they don't know that NSAIDs are the number one culprit. The Aleve Motrin, ibuprofen that take over the counter for Pain is actually hurting their kidneys over time. It won't happen in a day or two, but if you are consuming those medications regularly over a long period of time, they can actually causes inflammation in your kidneys. And the way way we detect is by the urinalysis which shows high eosinophils. So eosinophils are increased in your kidneys causing more cytokine release, more scarring and causes kidney damage. So NSAIDS is the number one culprit. Now many studies are coming up, they are showing PPIs like Protonix and omeprazole and all those, not the ranitidin but the PPIs are the main also culprit which is linked with the chronic kidney disease. Yeah. So if you are taking PPI for acid reflux for a long time, talk to your providers to see if they can wean you off those medications which are linked with the chronic diseases.

And the interesting caveat to that is people are taking these NSAIDs, ibuprofen AD for what? Inflammation. Because they hurt. Right. Which is normally a result of, of you know, obviously inflammation and likely a dietary changes, high blood sugar, diabetes, that's driving all of that to happen. So now they have the nsaids plus they have the dysfunctional dysregulated blood sugar which is like the perfect storm and they have no idea. Right.

And then you add the PPI on top of that because their stomach is irritated from taking the NSAIDs. Right. So we're adding insult to injury. Absolutely. Sure. So what other things affect renal function that we may not be considering? You know, I think about heavy metal exposure, environmental heavy metal exposure, just day to day exposure, just in our water. Is there a concern there or is it not a concern? Like what is your thought there?

I think it is a concern. Absolutely. I would encourage everybody to test their water. These kits are available in Home Depot at a very reasonable price and you can actually get those water tested for heavy metals. Heavy metals like lead, chromium, even copper and mercury, they are linked with chronic kidney diseases. Not only that, they can affect your neurological health. It causes dementia, tingling, numbness, neurological damage and cardiovascular diseases. So it's very important to keep that under check. Nowadays people are consuming farm raised seafood and sometimes if you are eating a lot of seafood from the sea, even it's rich in mercury. So you have to keep that under check. Maybe twice a week of the seafood is something we can tolerate but more than that can cause mercury overload and then the soil is all contaminated. If you are not eating organic, make food from Reliable sources. The soil is full of contaminants and the heavy matters and the toxins. Similarly the plastic, the bpa, they are all leading to inflammation and indirectly harming the kidneys.

Right. Dr. Sharma, can you go back to the kit from Lowe's? I'm really curious in testing home water, like how. How what. What kit is that and how do we do that?

You know, I actually tested my home water last year with the. I just got like I Home Depot for. For something and I found those flyers there. They. They are giving some kids to buy. And you know, I don't remember the exact name of the kit, but if you look up the website, I'm sure you will find it. And then when I did that test, I sent it out, they showed the detailed analysis of my water. There were some concerns because you know, the EPA doesn't tell the. The reference ra very something which I. I'm not, you know, considering because those reference ranges are actually. I would not have that much amount of chlorine or heavy metals coming in my body because EPA says that this much amount is okay to have. But why, you know, why would we have those chemicals in our body which eventually gonna get accumulated and cause inflammation? So then I ordered am kit to test it further and they gave me the whole like I think I have 30 pages of my water analysis and I found that it is contaminated with some heavy metals. My chlorine levels in the water, home water, which is a city water, is very high. So I had that reverse osmosis system installed and they just tested it last week and they said it's even better than. Than ten times better than the water bottle.

So bottom line is there is an easy way to test your home water. I did not know that. I think that's fascinating. I will definitely do that myself. It sounds like it's something you send off and then they send your report.

And knowledge is power, right? So and recognizing the bioaccumulation of all of those things, it may not just be the chlorine in your water. Right. It's all of the things compounded together and it's very hard to clear those. Right. The kidneys are, you know, it's a workhorse. They're a workhorse to. To clearing things. So and this is just a question that I have curious. Is kidney disease a circulatory issue?

I would say yes and no. It is actually more inflammation at the cellular level. But how it starts, it could be from circulatory problems. So if your heart is affected in many cardiomyopathy patients with congestive heart failure, they start having kidney issues down the road, and that's because of the circulatory problems. There are various hormones in the body, like renin, angiotensin, which are also affected by the kidney function. And when the kidney function is off, those hormones which regulates your blood circulation and your blood pressure, they become off, and that causes high blood pressure. So it's like a vicious cycle which. Which. So kidney disease can affect the circulation, and the circulation can affect the kidney also.

But root cause typically is inflammation, from what you said. Right. So targeting those drivers of inflammation is just an empowering thing for people to do at any age. So a lot of people with renal changes think that it's too late. I think they get the message. Once you have kidney damage, you have kidney damage. Right. There's nothing that can be done about it. Right. Just wait until you need dialysis. So what would you say to that?

So I used to believe that till last year. Okay, so it's a myth. Once you have stage four or five, your kidney function is not reversible. That is true, because it causes fibrosis in the kidneys, and the loss of function is usually not reversible. But you can still optimize your kidneys so that you don't end up on dilution. And it will delay the progression of kidney disease if you optimize your health. But stage three and even stage two, I have seen those patients getting. Actually reversing their disease by applying these functional medicine and root cause principles and helping them decrease the inflammation in the body, regulating the hormones better and better metabolic health, they can actually reverse their kidney function option.

And I can imagine it has to do with the. The preliminary driver that caused that kidney disease. And I'm. I'm bringing that up because I remember a very fascinating case I had many years ago with a young guy in his mid-30s who came to the clinic because he just wanted to optimize his health. And we did some basic, you know, we did not some basic. We did Cleveland advanced panel, you know, looking at hormones, looking at everything, and he actually was in stage three three. And he was, you know, it was. It was a very big surprise for him. Long story short, he had been exposed significantly in his home to mold, and he had cleaned up, he had done the renovation, and he basically had it triggered an autoimmune kidney condition and got super sick sick. He has been able to reverse that really nice. Quickly picked it up. So are you seeing some of, like, that may be One reason, you know, mold and biotoxin. But have you seen some other things that maybe insult quickly, that if caught quickly, they can be reversed?

Oh, I have seen that all the time. Dehydration is one of the factor which I mentioned. I've seen patients coming in with dehydration, their kidney function improves when they are hydrated. I. A patient who was in mid-50s was exercising like two, three hours a day. His CPK levels were elevated and he had kidney problems when he came to me. So when I looked at it and I sent out all the evaluation, I found that the CPK levels were elevated. And then I started questioning him, like, why are you sore somewhere, how much exercise you do? Then he told me that he's doing like, gym, he's running, he's like two, three hours a day with extensive workout, and he has a big build and he's also chugging down all the protein shakes and everything together was causing his kidneys to be overworked and tired. So I gave him a protocol to help him with the kidneys and his kidney function, CPK levels, everything normalized. So those are the conditions, if we found out the cause of it early on, they are really reversible. And stage two, stage three, is totally reversible. I agree with that.

And in the name of doing good, right. He was working out probably to counterbalance, you know, other things in his life. Right. And we do so many things sometimes in the name of good, but oftentimes overdoing it. Right.

I have to tell you, I had a young patient who was actually getting all these supplements to help him, you know, improve his muscle mass, mass. And he came to me with kidney failure. And when I investigated more about his supplements, his taking, I found out that one of the supplements he was on had a diuretic in it and that was causing his kidneys to function hard and dehydration and causes kidney failure. So when we removed that supplement and his kidney function normalized within two weeks, months. Wow.

And lucky that he met you and it was investigated and he was taught because there are, so you speak to, you know, kind of supplementation as a whole, our firm belief is that supplements are not going to fix the problem. Right. They fill in nutritional gaps, but the right testing, right. To identify the right product choices. Right. Go. You know, having someone in your life that's guiding you and teaching you on how to purchase, purchase, and also knowing that there are supplement drug interactions or supplement supplement interactions. So really bringing someone alongside like yourself, Kelly, myself, or another professional who's trained to do that to make sure that what, again, they're intended for good. Right. But not so good.

Yeah. So I had recently patients on GLP1 coming in with acute kidney injury and that's because they are not taking the right dose, the right protocol with chronic kidney disease and that that harm them. So once you adjust that actually it's, you know, it's reversible and it helps with the kidneys, GLP ones, they are very good peptides which are actually helping with your blood sugar, with insulin resistance, with your heart and kidney health. So we give that all the time. But in some patients you have to be careful because if you are not checking their labs often and it might in some cases, especially like there are other drugs, like as you mentioned, the interaction between different medications. There's interaction between GLP1 and other medications people are on, they can cause kidney damage. So we have to be mindful and be diligent in finding out the cause. Yes.

The challenge is that people are buying these GLP1s on places that they're not knowing where they're coming from in many cases. Right. And they're not being dispensed them through a practitioner who's being diligent in monitoring those things. So I just, I had to say that, I had to interrupt that because our consumers and our listeners need to hear that is that those things are not intended to be done just for, you know, just the loosey goosey letting someone, you know, dispense them. They are intended for a time for the individual. Right. And for someone to be looking at their whole body care and protecting them in the process of again doing something for good. But compared to dangerous.

Absolutely.

Yeah. So, you know, now social media is full of the new companies which are saying text, text this number and we will send GLP1 to you. Like who is overlooking where it is coming from? What those you're prescribing. Are you even looking at the history of the patient? If they have pancreatic problems, if they have men one or two cancers in their family, why are you giving them GLP now? You know, there is a black box warning from fda. It's related with thyroid cancer. It causes the depression and mental health problems. We have to be mindful about what we are giving to our consumers and they have to be intelligent enough or maybe more curious enough to know where it is coming from and is it really good for me.

So back to the supplement question. I get oftentimes asked about creativity.

And.

Yeah.

And it's just one of those things, there's a caution in my mind, you know, I don't know if that's a valid caution or not. So I would love to have your input on creatine supplementation. And I'm getting the question about brain health. There's a lot of new literature coming out about creatine helping with brain health and cognitive function. And obviously people use it for muscle building, too. But I'm not talking necessarily about our hour gentleman in the gym trying to bulk up. I'm just talking about general use of creatine.

Yeah. So, you know, it's an interesting supplement, I would say, and it is actually. It has a lot of benefits, as you mentioned. It has benefit of brain health. It causes more muscle mass, I would say. Like in advanced kidney disease patients, I would not prescribe them or recommend them to go for creatinine. It's for the same reasons because it has to be processed somewhere and it's mainly in the kidneys, and kidneys have to get rid of the byproducts. So you have to be mindful in stage four and stage five of kidney disease patients because it can actually worsen the kidney function and shorten that path to the dialysis. But in stage three, two, I think it should be okay to take for the potential benefits that you has.

And I think to Lori's point, monitoring labs after, you know, what happens after you initiate, you know, are we creating any problems? Because we are all individual and there.

Is a threshold there and you can't manage what you don't measure.

Yeah.

And so really having a relationship with a qualified healthcare practitioner. Right. Who's done the training and done the time, who can look at these through that critical lens and really guide. And, you know, I just want to keep reiterating that because, you know, to your point, to all of us is there aren't. There aren't a lot out there and you have to do your research and finding those that have done the time and. And actually not gone to just a weekend class and have it hang that shingle out that says, you know, we're a functional medicine provider. No, they've done the time, they've done the education, they're continuing to do that, you know, and, and I hear that that's, you know, you did that through ifm and so. Which is a fantastic organization.

Yeah, it was. It's a very rigorous program you have to go through. Actually, I didn'. It's going to be another medical school for me. That's right.

Yeah. But aren't you glad you did it? Like once you see it, you can't unsee it, right?

Definitely. Definitely.

Yeah, yeah. I have a question about foam in the urine. I get a common question, what is that? Should that be a concern? Some people are like, I've never even looked. But I want to bring it up because I do think it's important. What do you say about that? What is that?

Yeah. So foam in the urine is actually protein in the urine which causes that foam and it is important to look at it. It's the early sign, sign of kidney damage. And even if you are not diabetic, you might still have protein in the urine from various reasons and it might be prediabetes or early signs of diabetes. There is IgA nephropathy, there is obesity causing the FSGs in the kidney, causing protein leakage in the urine. So protein in the urine is not normal. So if you have any amount of protein in the urine that could be the reason that you're seeing that foam in the urine and that's the early sign of kidney problems.

Yes. So for our listeners you should not have, you should not have protein in the urine. No amount of protein is normal in the urine and does need to be investigated for sure. So foam can be just a way of visually not always. Right. You may not always have foam if you've got protein in your urine but if you're seeing that, you definitely want to report that.

So as we close and I don't know Kelly, because I could keep you on here all day, Dr. Sharma, but I know that you've got an important event to go to and maybe we need to do like a round two because I, I think that it would be fantastic. This has been good time spent. But if you were to you know, leave our listeners with just two or three things that so important in relationship to kidneys, give them two or three priorities and how to improve the health of their kidneys.

Yeah, you know, I would say that just be mindful about your lifestyle. If you are at the high stress level level and eating all the junk food or emotional eater, you have to start from there. Be mindful about what you are drinking, keep yourself hydrated and avoid those over the counter medications which can be potential harm for your kidneys.

Yep, that is awesome. I think that it would be really Fun to have Dr. Jim Laval on here with Dr. Jarva and us too and roundtabling metabolic and kidney and just overall health and function. So we're gonna have to stay tun for that one if that's okay with you, Dr. Sharma. We might have to reach back out again and continue the conversation.

A lot of fun.

We love it. We look forward to seeing all the great things you're going to do in this functional medicine space.

Yeah.

Thank you so much. Yeah.

Would you leave our listeners also with how do they contact you? And you know, just if they want to hear more, where would they go?

Yeah, so, you know, they can go on my website, Zeal Vitality with z e l vitality.com they can contact me through email with staff Zeal vitality.com or I'm on social media, Tick tock, the Instagram, Facebook at the Kidney Whisperer. So I'm happy to help.

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