Too Much Meat Will DESTROY The Kidneys? Here Are The Facts! | Professor Thomas Weimbs

to my mind it's a very clear cause and effect you know what is causing the chronic kidney disease is high glucose levels and you know the hyperen anemia and you know all these things that come with it for some reason it's not so clear to many nephrologists that I talked to um to them it's a mystery to me um diabetic chronic kidney disease is actually not really a disease um it's more of a toxicity welcome to the plant-free MD podcast with Dr Anthony chaffy where we discuss diet and nutrition and how this affects health and chronic disease and show you how you can use this to optimize your health and happiness both mentally and physically hello everyone thank you for joining me for another episode of the plantree MD podcast I'm your host Dr Anthony chaffy and today I have a very special guest uh Professor Tomic Thomas wimes from UC Santa Barbara who is an expert on uh kidney disease and function so a bit about uh Professor Ju he's a professor of um professor at the University of California Santa Barbara where he directs research a research laboratory focused on polycystic kidney disease PKD and received his doctoral degree from the University of cologne in Germany and then conducted conducted post-doctoral research at the University of California San Francisco uh Professor Wes thank you so much for joining it's a pleasure to see you again it's great to be here Anthony right so um for those who don't uh who who haven't come across your work and don't know too much about it can you tell us a bit about your research and and what you do down at at UCSB sure yeah absolutely um yeah as you mentioned um so my my research Focus has been on polycystic kidney disease for quite some time so probably 20 plus years or so and um what is polycistic kidney disease um it's um it's a genetic um disease it's essentially a genetic form of chronic kidney disease and um as you probably know you know your your listeners know chronic kidney diseases is very very common um so chronic kidney disease or CKD affects you know something like 10% of the population um so it's um extremely common and most forms of chronic kidney disease are of course caused by um type 2 diabetes um and um but there's also a small fraction you know like 2% or so that's caused by um genetic um diseases uh and the most prominent of those is polycistic kidney disease or PKD um so people both PKD you know they develop the disease and you know we've been studying this um there's there's not really any satisfactory Treatment available um so for many years we have looked at molecular mechanisms underlying the disease um and trying to find out you know the next new drug Target that we could go after um and and um and I'm sure we're going to get into this um so we have actually stumbled on something completely different um where we have seen much better efficacy that has to do with dietary interventions as opposed to pharmacological interventions um so that has kept us busy um in uh in my research lab um so obviously I direct the research lab um at the University uh in addition to teaching and so on and we also launched a company uh um you know few just a few short years ago um based on on these dietary research findings uh and you know we came go into all of that as well yeah yeah so I mean that would be the traditional method would be treating this pharmacologically have have you found or has there been uh much in the way of pharmacological interventions for PKD or is it uh pretty uh Barren at the moment yeah it's pretty Barren there's um exactly one um approved drug in the US and you know essentially worldwide so one drug is is out there um this drug is you know better than zero drugs um of course um but um it's you know it does not um stop the progression of the disease um let alone improve anything um so patients even on the drugs are still progress um eventually to kidney failure um the drug might buy them a little bit of time um unfortunately the drug comes with toxicities and side effects um so there there's kind of a tradeoff there um you know there's liver toxicity for example patients have to be monitored pretty closely when they're on that drug um the um the drug also induces polyurea which means the patients you know they're very very thirsty they drink something like 10 liters of water a day or so and which means you also have to pee out 10 lit of you know pee a day um which means they have to go to the bathroom you know pretty much every hour or so you know um essentially you know um day and night um so it's a you know big impact on their lifestyle and it's just not compatible with many careers and professions and so on but imagine you're an airline pilot or something and have to go to the bathroom every hour I don't think that would work um so it's you know I think everybody would agree that there is room for improvement um with managing the disease yeah yeah and so what were some of the the the dietary interventions that you found and um and how did you find them to be effective yeah so this came about um so we had been working for many years on the mtor pathway um which um you know I'm sure you know all about um that's one of these signaling Pathways that is um partially regulated by you know by growth factors but also regulated by the nut nutrient status of cells um and um we um are actually this was a bit of a chance Discovery so I had a grad student in my lab um who was working on on the you know mour regulation and how it might drive polycystic kidney disease and how you know we might be able to you know trick the cells um into doing better things and um he reason that um if he just feeds um the mice um both polycistic kidney disease if you just feed some less food that might affect the nutrient status of these cyst cells in the kidneys and might you know decrease M activity and slow down disease progression so um that's not something that I would have thought would work um seemed too simplistic um for me and you know luckily my student didn't ask me he just did it so um sometimes there's a you know it's good to be like at arms length to your students and let them do their thing um so he did the experiment he essentially put um these M with polycystic kidney disease on a uh on a restricted diet you know both um restricted food intake um only some like 23% less food intake okay um which is you know kind of a very mild restriction and it didn't cause any change in body weight gain and or anything like that the mice were very happy and healthy M and it turns out the only thing that was different was that their polycistic kidneys did not progress um so the um the kidney stayed smaller looked much better much healthier um and um you know we could also see that there was an in a decrease in in M activity as as planned um so that was good um but essentially we you know we published the paper um uh saying that you know this works and we don't know why it works um so that was kind of the first publication that came out where we just said you know food restriction somehow is beneficial in polies to kidney disease at least in a mouse model um and then you know of course we started to figure out what's actually going on there mechanistically and one key observation was um that the mice um on the food restricted um regimen um changed their feeding Behavior quite dramatically um and the way that these caloric restriction you know people call them caloric restriction experiments um the way that they have been done for many years is you know you have your um control group of mice that is at libidum fed um so they essentially have food available all day long all night long and um you you measure how much the you know the control group eats in a week um or in a day and then um you put the pre-weight amount of food into the the cage of your experimental animals um that that is you know minus 23% let's say um but the difference is in that case they don't have a mountain of food in front of them all day long they only get once a day a pre-weight amount of food and that actually completely changes um the mice uh the mouse's um perception of Life they think oh food is restricted here I better eat it all before somebody takes it away from me and they essentially consume all their food within about an hour or so and then which means for the remaining 23 hours they are fasting um which actually means that in addition to restricting the calories you also push them into ketosis um for like a long stretch of the day so for about 12 hours um they're actually in ketosis um producing BHB um and I think that is actually turns out to be the key um so once we realized that you know we used other methods of of putting mice into ketosis you know keto high fet low carb ketogenic diet um even acute fasting um and um all these worked great um you know ketogenic diet was actually very very potent in in stopping disease progression um in fact it was so poent that it not only stopped disease progression but it actually reversed partially reversed the disease um so the existing cystic disease um you know reverted um which we had to almost deemphasize in the paper because reviewers wouldn't believe it um because it has never never been seen at that time that you know you could possibly reverse something like polycystic kidney disease um yeah and then um one other sort of interesting experiment was um again that I wouldn't have thought would work is um to to just supplement um beta hydroxate you know the main Ketone that is made by the liver during ketosis um would just supplementing it in the in the drinking water you know on top of a just a regular high carb uh rodent show um again there wasn't you know something okay in this case I think I said okay let's try it why not um but um I had no hopes that this would do anything but it did it essentially replicated um The Beneficial effect of um of the like a ketogenic diet in these mice um without restricting their diet or changing the died at all um so that was a bit of a surprise yeah definitely um and so I mean I suppose that that's how you sort of came to the realization that that BHB was was pretty a pretty key factor in disease process do you do you know by which mechanism it would be that that influenced it yeah so that's a big question that we've been trying to address um so um we um you know we published this this paper essentially saying okay BB clearly has something to do with it we still don't know what the mechanism exactly is um and um I you know actually got an NH Grand to figure that one out um so we've been working on this for quite a while and as you well know my BB number one is a is a molecule that is burned for energy um you know instead of glucose and kind of takes that over but it also is a signaling molecule um so um it has functions that are essentially independent of its metabolic function um it has its own receptor that's a g protein coupled receptor called GPR 109a um which um is in the literature not really known to be a be I mean it is of course clearly known to be BB receptor but it's not on on the Forefront of people's mind that there actually a receptor it's um it's called the nasin receptor U because that's how it was initially discovered so it it happens to bind to Mega doses of this vitamin um but that is not the normal function of it the normal function is to actually bind to bet hydroxate under ketosis levels um and um and then signal intracellularly um so that receptor has been one of on on our list of targets that we've been investigating um and but BHB also um of course um has anti-inflammatory properties um where it inhibits the nlrp free inflammosome and and thereby inhibiting many uh types of immune cells for example um I think that is high on my list as well um because um inflammation chronic inflammation is pretty much a ubiquitous feature in in all forms of chronic kidney disease including polycystic kidney disease um and so we actually have data I would say at this point it looks like it's all of the above um that BHP is doing um so we um we have um mice um in which the this receptor is knocked out so the GPR 109a is knocked out and and so it's in the context of polycystic kidney disease so these M have polycystic kidney disease but they're lacking the receptor which means if BHB acts through that receptor there should be resistant to treatment at that point and uh in fact there are um at least partially there's still still a bit of a beneficial effect um but it it goes way down so we think that the receptor clearly plays a role there um but we also um see very strong anti-inflammatory effects in the in those kidneys um with with BHB treatment and um we're very interested to figure out what what exactly are the immune populations immune sub populations that are most affected um you know we have a um you know some very new discoveries where we find a role of neutres um in in in progressing PKD which is not something that had been seen before so we very interested in that and and clearly clearly um BP inhibits those guys quite quite potently as well yeah yeah very good and so you said that this this could reverse some of the um the cysts and and in in polycystic kidney disease um to what extent how how much have you reduced down the uh the Affliction yeah good question so it's um you know it doesn't go all the way back to to a normal kidney I think that would be asking too much um um but we do see um sort of like a um you know Improvement in not on so in in cystic burden um so you know we can measure essentially the cystic index we call it um so that goes down and it um it depends a little bit when the intervention kicks in um if you start it early um the effect seems to be greater um and the later you start you know the the less of a um effect you get and I think that has to do with the kind of the ongoing fibrosis because these cysts essentially cause tissue damage and then the kidney reacts by you know inducing fibrosis here and um you know it's it's difficult to reverse things that once they fibrotic um we do see improvements in fibrosis um but my hunch is that you know once you a year you're very far along with highly photic kidneys and there's only so much you can do um so earlier seems seems to be a better way of of going about it yeah makes sense yeah for people that don't know they could probably look it up maybe we'll get a picture of it but polycystic kidneys are they're generally massive exists and they they grow up in a little tiny kidney to then this big monster uh bloated kidney that that typically doesn't work very well and these people are are quite unwell I've I've um I don't treat this you know normally but I've had patients that have come in for other issues who have had polycystic kidney uh disease and you know they they're quite unwell in general they have a lot of seem to have a lot of metabolic issues and they also uh age faster I just noticed that that a lot of the times that there's someone who's my age but they look 20 30 years older than me and they have and I find out they have polycystic kidney disease and like okay well that that sort of um explains that then you know it's not that they you know that they're doing horrible things to themselves it's just things are horrible things are being done to them uh by this disease process um but it's um is is it something that um is still in the preclinical phase or has there any been work done in in human trials as well hey guys just want to take a second to thank our sponsor at carnivore bar I don't promote many products because honestly all you need to be healthy is to just eat meat for those times that you're out hiking road tripping or stuck at work and you want a nutritious snack that is just meat fat and salt if you want it the carnival bar is a great option so I like this product not because it's just pure meat but also because I want the carnivore Market to Thrive as well and the more we support meet only products the more meet only products there will be available in the mainstream so if this sounds like something you'd like to get behind check it out using my discount code Anthony to get 10% off which also applies to subscriptions giving you 25% off total all right thanks guys yeah so there there are already trials um that have been done and many more that are um in the pipeline and have started even um so one thing we had done um um early on actually during covid times um you know when suddenly I had you know the lab was essentially shut down we couldn't do any more animal experiments um and you know my the researchers in the lab were kind of sitting around with nothing to do and uh I happened to have a a nephologist in my lab who was doing his Fellowship research in my lab um terrific Guy Sebastian strubel um out of um out of Germany um which you know is where I'm from as well um so he spent um the plan was to spend a couple of years in my lab and and do a lot of mouse experiments and um Co hit right at that time and U then I suggested okay you're a nephologist why don't we see if people um with um polycystic kidney disease you know which is you know fairly common disease you know there's about 600,000 U people with PKD in in the US um um and um one would think that amongst a large number of people with a disease um there's you know a decent number that might have done a certain diet already especially something popular like a ketogenic diet um so we um were able to recruit um over 130 um patients with PKD that had already on their own um experimented with with ketogenic diets um but you know everyone has done had done their own version of it of course you know mostly kind of internet based um keto um and mostly for weight loss and so on um and um but we found these people um and and did a retrospective analysis um of how you know how they did with it um so the average duration was 6 months um and um we had um like a long questionnaire you know that that was you know went over with um with phone interviews and so on about the experience and U but also their the essentially the Labs um U you know we we got them from the doctors uh to look at things like um kidney function right so what's called egfr the estimated glome filtration rate which is a sort of a measure of the kidney function and um we found um interestingly enough um that um not only did those patients um actually report that they you know felt much better but um also their pain levels went down uh and pain is sort of a common complication in polies the kidney disease you know sometimes um they call it kidney pain um and often times it has to do with you know just simply the compression of everything in the in the abdomen due to these very large kidneys um sometimes it seems that the kidneys inherently actually cause pain just on their own um so there was really good improvements with that um um but in strikingly there was um Improvement in hypertens so hypertension is very common uh in in PKD uh so that went down and kidney function actually um improved um statistically significantly in in those patients um which um seemed a bit of a miracle um of course there are many caveats to study like this this kind of self-reported data a self- selected group um of patients you know that essentially volunteer to to provide their data it is possible that many others might have done a ketogenic diet and they it didn't work for them and they never raised the hand to say I want to be part of the study so um of course they're caveats but at least um this looked um you know very promising so we published this study back then um and then at the same time we had already worked with um our friends and collaborators at the University of cologne in Germany um so we have a long-standing collaboration with them they happen to be um I would say one of the top um policies to kidney disease research groups there and um you know clinicians there um and um we had um you know then put together a clinical trial protocol for prospective randomized control study uh took a while to get funding for it strangely enough um even a patient advocacy organization that you'd think there should be all over it um you know it you know first the the grant bounced and then we had to resubmit it and uh you know a year goes by with um for enough for no good reason but eventually got funded uh this study started and um has been completed already and was published um at the end of last year uh this was a randomized controlled study um with people with policy the kidney disease they were divided into three arms uh control arms so no change in diet um a ketogenic diet arm and a um water fasting arm so kind of like periodic water fasting um and the intervention was for three months um so very short term um it was really designed only as a pilot trial not um with efficacy as a primary outcome but essentially looking at safety feasibility and so on and um so it turns out you know safety and visibility were no problem you know those patients are actually really motivated and they want to do something about their disease um so that that all looked great um and uh but surprisingly there was even an efficacy signal already um even after three months um so especially in the ketogenic diet group or I would say actually only in the ketogenic diet group uh so in the keto group um there was a statistically significant uh increase in kidney function so not only you know like no decrease but actually increase which is um again that is against the Dogma um the Dogma is that polycystic kidney disease is irreversible only goes worse of over time uh so in this case there was an increase and um so initially we um you know the the standard way of measuring kidney function is by looking at um the creatinin level in the blood um if kidneys stop working it it goes up and it can calculate with a formula what the kidney function will be of course the criticism is um that creatinine is you know influenced by the diet and by muscle mass and so on um so the initial comments we got back from from reviewers was oh this means nothing you know um this just because the diet change and so on um but luckily um you know then we also measured um another marker called stattin C which is also a mark of kidney function that is actually independent of muscle mass independent of dietary changes meat intake and so on and um this one showed the same increase um in in kidney function um which was great um and um we also looked at um what's uh what's called total kidney volume uh so all the patients got MRI scans um of their their kidneys and you can calculate you know the total volume of those kidneys as an indicator of progression um and um there was in the initial study there was a um a non-significant decrease in total kidney volume so the kidneys seem to have shrunk a little bit it just missed statistical significance um but in a post HW um analysis um that was recently done and and presented at a conference um where we looked at Patients um with um kind of sort of a constant ketosis um so um kicking out a few patients that had only sort of like intermittent ketosis um if you look at at those were robust levels of ketosis um there was actually a statistically significant um decrease in total kidney volume so again going against the grain and you know most nephrologists you know have a hard time wrapping the head around this m um but you know the data is the data I will say MH so this so great um and since then you know um we we have been and we have a whole pipeline of clinical trials um that we have um have been planning and you know one of them is already has started um and then those trials um however are through my U through this startup company um that I mentioned um uh Santa Bara nutrients so it's a company you know out of the University um where I'm I'm currently the chief ific officer and we have a terrific team um uh of of Professionals in there in fact um something like 10 people on the team have polycystic kidney disease and themselves um so everyone is kind of in it for you know for really good reasons I would say um the the funders of the company know the angel investors um all of them have polycistic kidney disease or their fam are affected by it um and and we you know we've come up with this um a product which is a medical food um called keto Citra um that contains exogenous um beta hydroxy bate um so similar to you know what we gave to the Reds and uh and so on um and um we're testing now um the um you know potential efficacy of this product um we cannot call it efficacy because it's not a drug um so only drugs can be efficacious um um so forget I mentioned that um so um it's actually labeled as a what's called a medical food um in the um so in the US you know as you know the FDA regulates um foods and drugs um they also regulate supplements and there's one more Niche category called medical foods that most people had never heard of before um and neither had I you know before we got into all this um and medical foods are essentially Foods um so they have to be safe um what's called generally recognized as safe the ingredients have to be essentially approved food ingredients which all of those are um and um so that's what the product is um and we're testing it in in numerous clinical trials now one has just started in Tokyo um in Japan um at jendo University that's led by Professor shigo horer um there um looking at 100 patients in the intervention group in 100 controls um all with polycistic kidney disease and um the intervention is essentially this um this medical food keto cetra u in addition to dietary changes um so ketogenic dietary changes um and that's a one-ear study so one-ear intervention um um so you know it just started um a few months ago so it's going to be a while until we have some data um and we have um um a essentially a duplicate study um planned in Toronto it's the University of Toronto with Dr yope um looking at 40 patients intervention and 40 controls with essentially the same study protocol um fingers cross it will hopefully start sometime soon it it's been delayed uh quite a bit so I was hoping to already have some data there um and then we have you know several other studies you know one with the Cleveland Clinic um that um would be a short-term study looking at metabolic outcomes um we're planning a study with John Hopkins University um with sort of a um a slim down version looking at um this medical food keto Citra plus um sort of a loow carb diet so not ketogenic but just like a lower carb diet um and um I'm I'm sure I'm forgetting a bunch of studies so planning one with University of Vienna in Austria looking at um at kidney stone risk and so on so yeah so there's currently a lot going on University of Southern California um there we actually put together um which something that I think was a nice study um um a 2-year trial looking at um only this medical food keto um um compared to standard of care so essentially no other intervention just only adding this medical food um which is sort of a study that all the my nephologist colleagues um um you know I talk to they're screaming um to hear that say I want to know forget about diet um change you know I don't want to do that with my patients I just only want to give them something such as a you know medical food um so we put that um study protocol together um and actually submitted it to the NIH um as as a National Institutes of Health here um for funding and it got a great review um you know see know the NH you know the first step is obviously um the peer review they have independent peer review panels and those guys really like the study they said that's exactly what's needed right now great study design great um you investigative team um and they recommended it for funding so it got a good score and was percentil with a percentile that is normally easily fundable um finnally um then the second round uh the second step in during the NIH review is then the the institutional review where the you know the top brass of the ni looks at all the the grants that were recommended for funding and they have a bit of wiggle room to say oh I want to we want to pull out the study that wasn't recommended for funding we want to fund it anyway or the other way around and it what they did is they um declined funding for this study um interestingly enough um and so against the recommendation of the peer review panel um they said no we don't want to fun um so we you know tried to find out what was the reasons and the official one of the main officially stated reason was that the effect size we have been seeing is too good so interestingly if something works really well that means you know you shouldn't study it um strangely enough so that was a reason um I mean so they said essentially oh nobody has ever seen such an um you know effect size in any pharmacological study or anything else in polycystic kidney disease therefore this can't be right that can be true or I don't know if they're doubting the data you know it's peer reviewed published data in in a really top Journal um so the conclusion was no we're not interested in funding this um we can speculate what the reasons really are but um um we're just going to try again and then resubmit it again um I think a second time they're not going to be able to deny it with of a silly reason like that I think yeah that's a bit that is a bit odd that um that's too good to be true therefore it can be well right I mean doesn't doesn't behoove an institution like the NIH to actually Chase those up you you see some some big example okay well let's see what happens and um instead of saying couldn't possibly be right you don't know you don't that's why we're doing studies you we're trying to find out you know is that case or is it not the case exactly and um so yeah that's that's very strange that they that they that I wonder if there's anything else going on that you know again because well no pharmacological mechan methods have ever shown this efficacy and because there's no money on the other side if these people had ties to Industry and things like that could that be influencing thing you have to sort of Wonder unfortunately hope you hope that it's not the case but you have to sort of deal with history and and human nature is that that that's happened in the past it will probably happen in the future yeah yeah it's you know hard to speculate but I mean in in a sense you know if um something like a ketogenic diet approach and you know exogenous ketones if that essentially is the most effective treatment one can possibly come up with um that also means that um that um the pharmaceutical Industries um you know there's actually you know maybe like about a dozen companies um out there that are currently developing drugs for PKD you know they have their pipelines and and everyone is going after their favorite Target that might wipe all of that out right so if there is a very inexpensive um treatment that is um so effective that no drug could ever reach it you know I think all these companies will put one and one together and say w we don't want to SN any more money into it so it's a consideration that essentially pharmacological research will stop um you know if if stud like this would prove that this actually works as well as we think it does yeah which would be fine I mean the thing is too is that then direct that money into something useful you know and we could actually help I agree yeah I agree to me that's fine as well yes right um yes um it's of course always possible that um big farmer sends a death squat to my house at one point but you know we hope that won't happen hopefully not yeah it's um you know I suppose you know I can see from your um clinician colleagues point of view that it is a lot easier to just prescribe a medication someone comes in with a problem you have this here's a medication or or or a meal you need to eat these Foods you know and this and this will help you that is a lot easier than than talking about diet and lifestyle but I find that for me in my practice anyway you know taking that extra time 45 minute consultation sometimes an hour you know going through things thoroughly and you lay the groundwork and you just explain to them why their blood markers are off and why their you know health issues are the way they are and you relate that back to food and insulin resistance and and all these other sorts of things and um that that is really uh powerful for them and and you don't have to do that every time you know you just have to lay the groundwork properly and and give them resources that they can look at on their own they're very selfo um they're very motivated like you said you know people with PKD they really want something that works and there there really isn't anything so they can't really be Cavalier about that it doesn't really matter because does matter and and they don't have things that can really help them and and save them uh if they let things go too far and so they're very highly motivated and they want to they want to get better and you explain to them that this can help and that this is this is a pretty straightforward way of doing it and this is why this works or to best our best of understanding why this works um I I find that they I have very high compliance very very very high compliance right and so you know I think it's I think it I think we're selling ourselves short as as clinicians on how effective this can be and how effective we can be and um you know most people have 10 minutes per patient but if you if you account for that longer initial visit you can you know you can uh make up for it later on right yeah I totally agree you know I have many dear colleagues um in in the nephology circles and you know you know many friends and so on um but I think the one of the the first impulse reactions I usually get is um oh but no patient of mine could ever stick to a diet anyway um so they wouldn't even want to try you know um so you know I usually ask them have you tried it um because in in my experience um um there's um there's huge motivation especially um people with um a genetic disease like polycistic kidney disease um so they have typically seen you know one of their parents or grandparents aunts and uncles and so on go through the same disease progress and uh progression and they might have lost their kidney function might have been on dialysis and maybe died on dialysis um so they all know what's coming um and they have it maybe graphically you know sort of in their minds what's coming they want to do something about it um and um they're actually very educated um so I I've had um um a Facebook group um of my lab um for many years uh and initially I just set it up you know for students and alumni to you know to be in there so we wouldn't lose track of each other but turns out that lots and lots of people with PKD joined um and now it's it has um I forget the number like something like three and a half thousand people with um PKD are part of the the group um and you know there's lots of life discussions um people say hey have you seen this paper yet and they're discussing it and um Everybody discusses diets and so on um so those folks are really motivated um to learn something and and do something about their disease and most um of those um folks in in those discussions um say that they essentially get no support from their nephrologists um if it comes to diet um they getting being are kind of brushed off um essentially unfortunately um and part of it probably also has to do with um sort of a fear amongst um doctors not to do anything that is not FDA approved or not in a guideline right so it has to be one of those two things either it's approved by the FDA then if something goes wrong they can just blame the FDA or it has to be in a guideline so if something goes wrong you blame the guideline if it's neither they're very very uncomfortable and they I think many nephologist actually thinks think it is somehow illegal to do something that's not FDA approved or in any guideline um I mean it almost doesn't matter what I say to them um they that's just how they're trained maybe educated um and maybe it has to do with medical malpractice fears and so on um that their insurance wouldn't kick in you know if something goes goes wrong there um you're a practicing doctor you probably have much more insight there but but the motivations are you know to stay away from anything that's not approved and not in a guideline yeah well it it's um it's cya Medical Practice cover your ass uh when practicing and so um and and that's fine you know what the guidelines are and you know the guidelines we talk about how we want evidence-based medicine right we want we want practice medicine based on the evidence you this goes back to hypocrates you know just do things that that you know work don't just like you know pray to the gods and things like that you know try something if it works keep doing it if it doesn't stop and so that there was that but you know so that's evidence-based but you know a lot of the evidence comes from your own personal experience you try something with your patients because of something and you see that actually this helps and this works and then you get this idea and then you can publish studies and you can do all that sort of stuff but it starts with what you're seeing and if you try something you do a ketogenic diet someone hears this and tries a ketogenic diet with their polycystic kidney patients and they find that it's making them worse and like okay well can we figure out something is going on doing everything right no no everything's fine it's getting worse fine then you don't do it it doesn't matter what A study says but you know if you think okay well maybe this can help and it does help then it also doesn't matter what any studies say and it doesn't matter what any guidelines say you can see with your own eyes what's happening to your patients and that's really what matters and sometimes you try different drug with a patient it doesn't really work well it works with other people so it has to work with them well no it doesn't and you try a different drug and you try a different drug and you try a different treatment and you try all these different things this is part of that it doesn't hurt anybody it's not harmful it's not going to hurt them so you're not doing any harm um and then you can see does this help and it doesn't matter what A study says after that but and so I think they'd be fully you know in in their and uh protected I mean they're not going to because they're not going to hurt anybody um but you know we talk about the guideline medicine guideline medicine is I mean the guidelines are are 105 years behind the evidence you know it takes it takes it takes a decade or more before the evidence of today that is commonly agreed upon in the medical establishment then gets into the guidelines there's a lot of bureaucratic red tape that get in the way and also they don't even look at the guidelines more than every several years so it takes time and you know so practicing EV based medicine well this is what the evidence shows we have randomized control trials we have you know retrospective analysis we have preclinical postclinical uh data okay well let's give it a try on my patient population um see what happens but you know that's evidence-based medicine but that's already two years behind The Cutting Edge because you had to have that idea and your grad student had to sort of do something behind your back before this even happens so someone had to you know say hey let's try something let's try something new and for something to be published in the literature someone has to try it you know and someone had to had to actually try this on real people and so as a as a as a doctor I've read um Atul gandi who's reading wrote a book called better how people had very different outcomes as doctors and how to get different things and and he was talking to a doctor that that had some of the best results with cystic fibrosis in America far above the average and uh he was doing different things things for his patients and Dr gue um asked him he said hey you know it's actually a lot of these things you're doing are you know um you know certain L on the guidelines but they're you know not really um with with like the current literature and things like that and he just sort of smiled and he just said if you follow evidence-based medicine you will always be two years behind The Cutting Edge and so that's what he was doing he was trying to advance our understanding of cystic fibrosis not just you know treated as best we could right now he was trying to make it better and that's what you have to do and so um and then if you're doing guideline based medicine I mean that's 15 years behind the evidence so I mean you're really far behind and but people do that because it's um you know they feel it they feel safe there um instead of trying to advance our understanding they're just trying to they're just trying to punch in their ninet to-5 and just go home without an issue you know you can understand that but that's not necessarily the best thing for your patients I've spoken to uh multiple people when they said they had colleagues in their department at you know whichever hospital they were working at and one gentleman told me that his um head of Department was was basically um you know saying that he shouldn't shouldn't use you know ketogenic you know approaches for his patients and um I actually believe he was a nephologist and he was saying he like well you know but this is this is the evidence look at this study and look at this study and look at this study and his head of department just said I don't care what the evidence says I don't practice evidence-based medicine I practice guideline based medicine if it's not in the guidelines I'm not going to do it it's like okay and um you know typically I would I would I I sort of think of the guidelines as a guideline it's a guide say if you don't have a clear direction to go and if you can't if you don't have you know the the experience and Acumen in your profession to say make it this is this is what I think is the best way to go you can at least use this as a guideline this to sort of guide you in the right direction and at least you're not going to make too massive of an error necessarily and you know for for a head of department and someone who's you know senior in their in their field guideline based medicine is is probably a bit too circumspect and you probably need to at least go with the evidence space you don't have to necessarily push The Cutting Edge but at least go with what what the current evidence shows to do the best for the patient hey everyone really happy to announce a new sponsor for the show and for everybody down in Australia Stockman Stakes who are delivering highquality grass-fed and finished pasture raised beef and other meats flash frozen and vacuum sealed to your door something that I've been enjoying a lot of myself recently as well they also have a great range of specialty items such as high fat keto mints and carnivore beef and organs mints with liver kidneys and beefart as well so use code chaffy today for free or order of beef mints or another specialty gift along with your order at Stockman stakes. comom and I'll see you over there thanks guys right but it's also interesting what is evidence um so yeah Strangely I think a lot of um so guideline the guideline writers they're often at least in the kidney field and they usually disregard things that are not randomized controlled uh Placebo controlled um you know double blind type of studies a drug studies essentially right um so if it's a drug study like this um it makes it into the guideline if it's not um it doesn't it it actively gets um suppressed um and as you all know in in nutrition um you cannot do anything Placebo control obviously right because your control group and and your intervention group they know what they're eating so Placebo control is already out the window so you can essenti you never reach that um that standard even randomization is very very difficult in nutritional studies um because the patients the subjects know what they're eating they know which group they're in right and nobody ever wants to be in the control group right so um so we have a hard time recruiting um if we cannot fill the control group of anybody um and that um that is how drug Trials of course work you you fool the patients in a giving them a placebo so they have no clue which group they're in that's the only reason why you can do those studies why because you're fooling them um and it makes sense you know for drugs um but it doesn't make sense for nutritional studies right to have um you know to insist that it has to be randomized controlled and Placebo and double blind um that's just not realistic which means that anything any nutritional study will never reach that bar of a of a kind of an FDA proof um type of drug study so it will never make it into guidelines you know almost by definition so it's um yeah I agree um I think it you know um doctors that are only thinking oh I only do evidence-based things and only guideline based things you know they inevitably will be behind the times and you know hopefully one of these days they um get replaced by by more Adventure folks that have more success with their patients yeah I think I think that's the most important evidence is that you know what what you try with your patience and and what works and so you know expert opinion is is is considered low down on the evidence hierarchy but it's the most important thing for you in your practice and in your life and if you're a patient and you're having this and you try certain medications and they do what they do and then you try these different sort of uh therapies and they work much better for you it doesn't really matter um about the aages and the odds and the thises and the thats and did this come to statistical significance because it came to statistical significance for you it worked for you and it's that's 100% of the patient population that is uh that we're concerned about here is is what is happening to your body and when you know my practice and I I I think there's copious amounts of evidence to support the decision to try to change the way you're eating to affect changes in these Myriad medical issues that we treat these days um and so I I talk to my patients about that I properly inform them give get informed consent discuss what this means discuss how that that can play a role in their health and uh they agree to it they want to do it and they try it and it works again and again and again and again and again and again that's really the only thing that matters like you know I got you know I'm on a hot you're you found a winner and you're just like nope nope no we're just going to keep doing this and um I think that's the most important uh evidence for any individual clinician and then you know looking to to publish some of my outcomes for my patients you know case series and and and so forth and Dr David unwi in the UK has done the same thing and that's that's really helped as well now it's not a randomized control trial we definitely still need those to really prove this point but it's um it is evidence and um you know the only reason we're doing any studies is to try to see what works but if you think okay well I think this is this is safe and uh and we're going to see if it works for my patients and it does work well that's all it comes down to we are trying to the study is just trying to is trying to help guide you and guide clinicians and guide patients to doing things that are that are of benefit for them and if you try them and they're beneficial then that's all that really matters at that point right yeah I totally agree yeah um oh I was just going to say so I mean obviously your your main field of expertise is in PKD um and you've seen kidney function improve for those patients um do you know about other patients this is a question that comes up all the time and I've certainly come across paper saying that higher protein diets are actually good for for kidney function I've seen that in my practice but what are your views on uh you know High higher protein higher fat ketogenic for for normal kidney like for for people without PKD they may have chronic kidney disease yeah for sure um I think that the same strategy um that I think works for PKD um will work for essentially any form of chronic kidney disease um um maybe even especially you know diabetic nephropathy diabetic um CKD because there to my mind it's a very clear cause and effect you know what is is causing the chronic kidney disease is you know the high glucose levels and you know the hyperinsulinemia and you know all these things that come with it um for some reason it's not so clear to many nephrologists um that I talked to um to them it's a mystery why people with diabetes um develop chronic kidney disease often times I say oh we don't really know the mechanisms and so it it baffles me a little bit um that that's you know that the um well let's put it that way to me um diabetic chronic kidney disease is actually not really a disease um it's more of a toxicity right um so a toxicity syndrome right so if you eat whatever Le based um paint chips off the floor all day long you know as a doctor what you would do is not you know give some kind of a you know something who take the pain away but you tell the patient oh stop eating the lead based paint chips right so you have to first take away the the toxic um um the reason form for the toxicity um and that's nobody thinks almost nobody thinks about it in the in the renal field um that um diabetic nephropathy is actually caused by the diabetes so first address the diabetes um you know get the blood glucose under control and that is not not a thing um blows my mind why that is um seems obvious to you and me and you know many others but um anyway so um yes so I think um obviously you know a ketogenic um intervention is probably the most effective way of addressing tpe tube diabetes and that seems clear again to you and me but not everybody else um and um so we actually um published um a couple of review articles um recently over the last few months you know of putting all the arguments um together and you know the clinical evidence together that actually says exactly that you know um that a low carb ketogenic approach um you know is likely to be the you know the approach one should take first um before adding drugs you know you first you subtract essentially the toxicity there um yeah and um one so one interesting almost proof of concept if you if you will is um the sglt2 Inhibitors um but so that's the the the class of drugs that were initially developed for diabetes and now they're actually um being used in for chronic kidney disease um quite a bit and um you know nephrologists are really excited about them because For the first time in a long time there are some docks that actually seem to do something in chronic kidney disease um and what sglt2 Inhibitors do is um they make the patient pee out glucose right so there you lose something like 80 gram of of sugar um you know by just peeing it out um and it leads to um sort of a low level of ketosis um so you know nothing great you know you don't get to like two Millar of of BHP or something it's a low level of ketos but there are ketones being produced and um there there is already a mechan istic Mouse study you know in M you can do these mechanistic studies that you couldn't do in humans um that study came out maybe a couple years ago um that really nailed it down um I think um that um the Reno protective effect of sglt2 Inhibitors is actually due to the BHB being produced um so it seems it seems clear except you know um nephologist somehow don't still don't think that way um they think there's some m serious um actions of sglt2 Inhibitors that are some kind of weird of Target effects that somehow protects the kidney and it it prob couldn't have anything to do with the glucose you know getting removed and ketones coming up um so that that The Logical conclusions somehow they they don't seem to happen um but nevertheless the drugs are popular um they're being used in the cost an arm and a leg and you know you could probably achieve the exact same effect by telling a patient to consume 80 gram less carbohydrates per day you know you'd have the same effect very likely for essentially no no cost um so yeah so it's interesting that that often times um a drug that actually does the right thing um is still um even though you know it comes like with with all kinds of side effects um but that is easily accepted um especially if the mechanism is being kept murky and and people are not actually told what what's you know that it's just simply the glucose that is being lost there yeah um yeah it is interesting how we we have all these these um medications that that interrupt how your body uses or eliminates carbohydrates you have other medications that stop you from absorbing as many carbohydrates in your gut and this is used for diabetes and then others that cause you to eliminate more uh glucose in your urine and this is good for Di diabetes and then we're thinking like well maybe maybe we should restrict carbohydrates oh no crazy y yeah you have all these drugs that that are doing that that are restricting carbohydrates and and yet you know we don't we don't restrict the carbohydrates um I saw a professional rugby player was on on Instagram and he was saying you know what he does before a big International test match and as a type 1 diabetic and he saying that he needed um his trainer doctor whoever told him that he needed five grams of carbs per kilo of body weight and so he was because of his weight he was eating 550 grams of carbohydrates a day uh in order to you know maintain his energy levels and things like that as a type one diabetic and so he's having to to inject and use insulin Andra I think so too yeah and whereas all we're trying to do is actually reduce the amount of carbohydrates some use insulin and use drugs to just reduce this level down and and obviously the less carbohydrates you eat the less insulin you need to use and um and I've heard people that don't necessarily really understand this that that well that you know when you eat carbohydrates then your blood sugar goes up and then your insulin comes up and that just drives energy into cells it's a perfectly normal uh relationship it's like yes it is down here in normal levels but when you're artificially jacking up your your carbohydrate level and your blood sugar to extremely high levels that are well known to be physiologically damaging to the body and your insulin is going up markedly to counteract that and get this into cells that's abnormal especially when people understand that insulin affects over a 100 different mechanisms besides glucose regulation and so you elevate it up to drive these energy into cells and then it stays elevated it's AFF all these hundred other mechanisms in a very un unbalanced sort of way and so I mean we're we're getting worse and worse results with the advancements so-called advancements of of medicine and technology and so obviously that can't can't be right right yeah no I totally agree with you and um you getting back to to our interest in in diabetic chronic kidney disease and and what to do about it um so that's actually sort of like really high on our list of of doing clinical trials on um I'm I'm convinced um you know the same approach will work really well there and you know you know some folks like David anwin you mentioned um have essentially already shown it and published it you know it's it's not being accepted um very much um in in the establishment because this wasn't a randomized control trial um but I think clearly um these folks improved their kidney function which normally they don't um um and and um so we're we're trying to work with um actually several uh different institutions and investigators um to just um gives us a try and I think um that um that the beta Hydrox the Ketone actually itself um has a um a beneficial effect so even if you're even if you don't take away the toxicity you know the the high glucose levels um if you you'd add essentially the bit oxyer rate um you know um I think it will um it will do some good um if nothing else it's probably the anti-inflammatory effects in in the in the kidneys um and um so that's something we're very interested in in uh trying out you know can we um get get some beneficial impact in diabetic nephropathy both even just as medical food keto um um ideally with some kind of um modest dietary changes maybe I would say you know way at least cut out the worst offenders you know you cut out the the sugars let's say and you know reduce starch intake um so to not go completely overboard um and at some point you know it's also of course a a question how scalable is something um so a hardcore um keto carnivore diet you know is probably the best way of doing it um but scalable scalability is a problem right so if you're if you're trying to turn like a subcontinent like India with one billion people into beef eaters you know that's an uphill bit battle um so that probably not happen in our lifetimes MH um so it's good to have some you know kind of some tricks up up the sleeve to um actually help people that um you know you know for one reason or another you just stick to the their uh diet and you know get rid maybe get rid of some of the worst things you know the ultr processed foods and and so on we could talk about but it's um um if you remove those and add something like an exogenous Keet to and I think that might go a pretty long way of already yeah absolutely and and the thing is too is that my patients that come in they're very highly motivated the traditional sort of pills and potions and things like that and going to their GP hasn't helped their situation they haven't lost weight there's they've tried eating less and moving more and taking medications and all these things and they're not they're not working they're feeling unwell and they're getting steadily sicker and so by the time they come to me that's because they it's all Word of Mouth they they see a family member or friend that significantly improves their health and they say I want that how did you do that said well I want to see this person you put me on a program and it you know it really worked so I have people coming in that that are very receptive to these sorts of things um and so for me I have about you know 100% of well yeah 100% of my patients that come in fresh and then I can I can talk to them about this from the beginning will will at least try and and I can point out why that's significant and say hey in a couple months when we check this these will all change in these ways and they do and so they say okay well this is clearly working and it's working in the way that you said it would and so so they they stick with it there have been maybe two or three people that after they've done like a you know very strongly ketogenic carnivore diet um after a few weeks or a month they just say I don't know can can we can we open it up a bit maybe ketogenic but not full carnivore or these other sorts of things they say you know maybe we can eat some more things it's like okay well you know you're diabetic and have these issues I really think you need to still be on a ketogenic diet uh but we can have other things in there too if that's if that makes things easier for you and they're like yes that would that would help invariably every single one it was only it was only two or three people who did it in the first place but each one of those people came back to me in in a few weeks or a month or two and said I think I need to go back onto the more strict version because they were they were feeling so much better and they had they were getting so much better results and so even though it felt restrictive at first it they actually really realized how much it was helping them and they said like actually that's probably something I can do and actually want to do it but that's a very specific patient population and a lot of people are not interested they their health hasn't gotten to the point that they are saying no you know that's it I'm going to fix it or they just don't care you know maybe their their their health is suffering and they're like I don't care um there are people out there like that and so you know you still need to help them you know you still need to have some sort of ability like yeah I'm not going to change that I'm not going to cut out okay fine what else can we do and uh and so that's that's great that you're looking at other sorts of mechanisms like exogenous uh you know BHB that can help them because you know any port a storm and if they're if they're not willing to you know do the what I think is the best thing to do at least they're doing at least we can do something for them right yeah yeah I totally agree um yes there's also a few you know some easy things um that um you know things like oxalate for example you know um so we've we've actually studied that in the lab and and um found that these calcium oxalate microcrystals you know that form in kidney tubil um and eventually can go on to form kidney stones you know that they're extremely disruptive um you know that cause massive cell injury a massive inflammation um and actually accelerate um polycystic kidney disease quite dramatically um so we can very easily make p worse in rats you know but is giving them oxalate um um and um you know um have also shown the same for calcium phosphate microcrystals now also for uric acid microcrystals and those are all these um the substances that just don't want to be very soluble and uh they give kidneys trouble if you cut out um those stressors um I think that already has quite an impact and it's fairly straightforward to do what even for oxalate um it's just a matter of awareness um you know which foods are you know through the roof in the oxalate contact uh content you know there's you know a bunch of them but um they're easy to substitute um same for phosphate for example um most of the I would say the dietary burden U of phosphate comes from these inorganic phosphate food additives you know in in alra processed foods and Beverages and so on um if somebody's aware of it and learns how to read ingredient lists um you can very easily avoid those um and just you know do something good for the kidneys without essentially having to do anything dramatic with the diet yeah I I didn't actually realized that You' done um experiments with oxalates as well that's oh yeah yes yeah so that's something we published um pretty much at the same time when we published the the ketogenic diet um results um um so that came about just essentially from a the from a like a hypothesis you know that had come up um with a long time ago and I could never find anyone in the lab to actually want to do it until finally I found someone that said all right fine if I have to I'll do it um and everything worked immediately uh really nicely right so um it's so easy to do you take some rats um both both polycystic kidney disease you um feed oxalate um or inject it you know however you want to do it and you see these um you know the massive burden of um calcium oxalate microc crystals in the kidneys popping up you know it's very easy to detect um and then you see all these injury Pathways um lighting up like Christmas trees um lots of um these the same Pathways sort of get activated that are usually activated in polycystic kidney disease anyway so it just makes things worse you see all these immune cells coming in U macrofagos um primarily and um if you then do the con Converse and um so the the best antagonist I would say for calcium oxalate microcrystal in the kidney um is citrate you know citric acid um because citrate um keates calcium and it just prevents the the the formation of calcium oxalate so essentially it allows the kidneys to excrete ox olate um sort of harmlessly without causing damage uh and that's actually the the normal function of citrate in the kidney um so Evolution has already thought about all this and actually um excretes um a certain level of of citrate um in through the through the urine and but it so happens um that many people are hypocitraturic oops excuse me and um especially in people with polycystic kidney disease their urinary citrate levels are usually very very low um so they are already at a much higher risk so if you supplement with citrate um you can actually um um stop disease progression quite substantially and so we've done this in in red models of PKD um so it is very very effective you you just put some citrate into the drinking water it raises the urinary citrate level it also um you formulated in an a sort of an alkaline way so it also raises the urinary pH um and all of this prevents calcium oxide crystals from forming in the kidneys and um it it greatly improves um disease progression that's actually the reason why there is some citrate in in this medical food product kitra um so that's kind of the second mechanism that we're addressing there so it's number one you know the kosis with BP and number two the um the microcrystals with the citrate and we actually found that when we combine those two betrian citrate um we get a synergistic effect that allowed us to reduce the dose of both of those and then still get a the full effect okay and so so that that's that's very interesting because a lot of people obviously you know contend with oxalate dumping and oxalate issues uh especially coming from like a plant-based diet or on a plant-based diet and there there are different sorts of ideas on how to best treat that but um from what you're saying if if someone had this oxalate issue via from dumping or from just ingestion that just taking citrate as a supplement could could ameliorate that is that right yeah I would think so yeah it would have to be um so the um so I would say alkaline citrate is is the way to go and that's essentially what's in keto Citra um so it is um you know it it raises the urine pH which helps actually with the the normal excretion of of citrate um because citrate urinary excretion is controlled by the urine pH if somebody has a very acidic urine pH let's say you have ph5 um chances are you also hypocitraturic um so you don't have a lot a lot of citrate there so raising the UR urinary citrate um the urinary pH is already um beneficial and then adding more citrate on top of that um really pushes things over the edge and I think um I would absolutely recommend this anyone who has oxalate issues um um to do that to essentially allow the kidneys to just excrete much larger amounts of oxalates and it would normally could uh could do um the the other way of reducing dietary oxalate is of course um by um um making sure there's calcium um in in the diet at the same time because the calcium in the in the diet um will you know bind to oxalate and um and prevent the the uptake in the GI tract um and that's um that's um actually one of the main reason why there is calcium also in keto Citra um so that um people even if they do have some oxy in the diet let's say they do end up eating a spinach salad or something um it it essentially neutralizes the oxalate in there um and prevents the uptake so it's kind of a safety measure if you will okay is is there any particular form of of citrate that people should take or is it um any anything available yeah so um what uh so the way we formulated keto Citra is um we spread out the cat I um so um citrate alkaline citrate you know the citrate is a base um and the um so you have to have something with it um and um we we using um a mix of calcium magnesium and potassium in there um so it's sodium free and that's for a good reason because there is actually um some some solid data saying that you know um excessive sodium intake actually worsens polycystic kidney disease and I think it's um I would guess it's actually less the absolute amount of sodium um and it's actually more the the relative um proportion between sodium and potassium um so potassium is actually very beneficial for kidneys uh and it counteracts um um the sodium um so that's why we made keto Citrus sodium free you know somebody wants more sodium that's the easiest thing in the world to add um of course um and um yeah so usually what um nephologist would prescribe is um typically potassium citrate um which you know for my taste has a little bit too much potassium if it's just the pure potassium citrate um um it um I think this can cause even more uh some GI issues um that you wouldn't necessarily have with this um kind of a more balanced electrolyte version of it all right very good um well I I think the only other major question that I had is you know with this with this sort of culture of uh wanting the randomized control Placebo trials it's not going to get in the guidelines and and and looking for drug targets as opposed to just what actually works and and underlying mechanisms how how do you see the future of of this line of research with ketogenic diets and and as an adjunct to treating these or even as a as a primary uh way of treating these things how do you how do you see that um building the next few years is this are we are we sort of uh you know doing something futile here or is do you think this is this is going to catch on in the mainstream yeah I definitely think it's not futile and um it's um you know it's great it's almost comes out of a kind of a bit of a Grassroots movement right so um it's the the crazy Pioneers um that are doing it right now and um but I think we we all have um you especially you know people like you right so you're on uh you're out there when of you doing podcasts like this and they reach lots and lots of people um so um that is actually I think a very important um so almost like an educational component um because these things are not in textbooks yet uh and probably won't be for quite a while um at least you know the standard medical textbooks so um I must say when so I had never really heard much about ketogenic diet as a as a you know scientist biochemist cell biologist um you know I knew all of course all the you know the underlying mechanism and so on um but when we first stumbled on this whole um um keto uh line of research in my lab you know um um I try to educate myself and it's um completely useless to look at textbooks you know because there's nothing in there um so I got actually my um I learned the most um from people like you and uh you know on on YouTube and and social media and podcasts and so on I think that's currently where the the real information is out there um and uh but I think eventually it will make it um you know there's now so many clinical studies um coming up of ketogenic metabolic therapy um so it's hundreds and hundreds um that are listed on clinical trials.gov right now they will all be published at some point and um you know it's going to be an avalanche of of data and results coming out um and um I think I mean maybe I'm optimistic but I think 10 years from now um that's when many doctors will start you know maybe using this as as a first line therapy and maybe 20 or 30 years from now that's when it will be regarded as medical malpractice not to offer this first to a patient um I I hope we will get there at some point but I'm I'm pretty sure we will you know the same happened with like lobotomies or something like back in the days that was the first thing you do oh there's a misbehaving child um with ADHD you know you chop their brain in half and you know done um now of course it's you know we we can't imagine anyone would have ever done that right so um I think the same will happen with with ketogenic metabolic therapy U so we'll get there and that's you know thanks to people like you um I think to a large extent educating even you know people like me that had never heard of about it um so I think you're doing you know a great thing there oh well thank you very much and I I'm I'm certainly optimistic as well I mean having having you know more professors and researchers such as yourself coming across this and seeing hey look there's actually some validity here and when you study it you find there's even more validity I think that that's that's very encouraging and that more and more people are doing that um we've had some some sneaky winds as well the um the guidelines in Australia have actually changed uh to include ketogenic diets for the treatment of diabetes and now it's actually considered best practice to treat um diabetes with a ketogenic diet which was actually the original treatment for diabetes was the only treatment we had type one or type two and um until we we were able to manufacture insulin uh but that was sort of sneaky because there was a a Dr James mui who won who's opthalmologist in Australia and for his his research in his Charities uh in in that realm he got named Australian of the year I believe in 2020 and so that was great and so we had this this sort of uh you know name and Heir about him and so he was just invited just just because of that to come on the board and help with the the government guidelines for the treatment of diabetes and he's like okay I mean doesn't treat diabetes directly except for diabetic retinopathy and uh but he knew about ketogenic diets and and he was well aware of the literature and the studies that had been done showing you could reverse type two diabetes you know ver the publishing uh publication from verta health and and elsewhere and so he really fought for it and he said that there are people really fighting against him on that and who knows they may have had you know pharmaceutical ties they all do pretty much and uh but he really fought he just really dug his heels in and he was able to convince the rest of the board and now it's in the GU lines and so it's uh uh it's one of those things that it's probably going to take a lot longer than that everywhere everywhere else unless we get someone like an Insider that really knows about this and doesn't have any uh you know conflicts that that would make him not uh recommend this but you know I think that that uh that's the foot in the door and um you know getting more studied out like you say there's hundreds of of studies in the works for for ketogenic metabolic therapy and various conditions and you know and there there are thousands of other ones have already been published so they just going to build and build and build and if we you know continue having these conversations and getting the word out there and people share and pass these things around to their friends with you know kidney issues uh or other sort of issues that could help it just grows and uh and hopefully we you know we sort of uh get to the point where where this is just Barn Door obvious that this is the way to go and that's my hope that's yeah not not too far fetched I don't think I totally agree yeah wonderful yeah so I would say keep doing the good work as I think it's just fantastic thank you well thank you so much I I really appreciate appreciate you taking your time um it's uh it was great to meet you we were at a conference together in Switzerland which was fantastic the keto live conference there we both presented and uh it was fantastic and it was an absolute pleasure to meet you there and it was great to be able to see you again and have you on the podcast so thank you so much for coming on I appreciate it super thank you Anthony great see you soon yeah oh and just and just briefly where can people find you find your work and potentially support your work as well oh yes absolutely um the um maybe the easiest way is to just go on Facebook and type in wimes lab so there's a a whole group there um anyone is welcome to join it's a it's a public open group um so anyone with an interest in in keto for kidneys let's say um there's lots of discussions there um people can also go to Santa Baba nutrients you know our startup company um it's easy to Google Just s nutrients um the there's a mailing list um and um lots of information there blog posts and so on um yeah so that's probably the best ways and of course anyone can always shoot me an email um I'm easy to find uh just wimes at ucsb.edu for example um yeah I'm always open to interesting ideas and discussions and and and so on right well perfect and well I would definitely encourage anybody with with kidney issues to go on that Facebook group and and contribute and talk and you if you are new to this and you need some help and support I'm sure there's plenty of people there that that will be able to give you their their um experiences and help you along the way and especially for people that have been doing ketogenic carnivore diets and similar and and uh you know it's it's great for them to get into the Facebook group too to to relay what their experiences have been positive or negative hopefully hopefully more positive than negative but you know just to to further our understanding of this and help people understand what to realistically expect uh from their kidney disease in certain circumstances so I do encourage everyone to to uh check that out and join there and I will put the the other links for uh Professor wimes uh in the description below so thank you again Thomas for coming on it's been an absolute pleasure super thank you Anthony no problem hey guys thank you very much for taking Tak the time out to listen to what I had to say if you like it then please like And subscribe to my YouTube channel and podcast and if you're on YouTube then please hit that little bell and subscribe and that'll let you know anytime I have a new video out which should be every week if not more and if you can share this with your friends that would help me get the word out and let me know that you like what I'm doing thanks again guys