Giving Credit Where Credit is Due

I’ve been feeling awfully thankful these past few weeks. Nothing like a health challenge or two to make you realize just how much you have to be grateful for. 

I’m not sure if you know it or not, but my husband – Paul Garwood, better known as Bear – has been my photographer for over a decade. Periodically I’ll think to mention it but, to be honest, haven’t mentioned that I am amazed by how he’s continued to do this (and do it well) despite his own health challenges. Thank you, Bear. 

But let’s not stop there. I’ve been highly active in the Chronic Kidney Disease Awareness Movement for over a decade. During that time, I’ve met others on the same path. The American Association of Kidney Patients has honored one of our own with a National Award and I’d like to honor him, too. 

“Organization Category: Urban Kidney Alliance, a Baltimore-based non-profit, focused on advocating, and empowering individuals in urban cities at-risk for chronic kidney disease (CKD) and other conditions. Award accepted by Founder, Steven Belcher, RN” 

Steve not only interviewed me on his show May 20th of this year, but guest blogged while I was laid up. Thank you, Steve. 

There are others, many in fact, that I’ve omitted. To you, I offer my apologies.   

My final gratitude for today’s blog goes to our kidneys. I’ve just learned that they produce glucose. Is that common knowledge? It was new to me and I wanted to know exactly how they do that. This is what sparked my interest: 

“…traditionally, the kidneys have not been considered an important source of glucose (except during acidosis or after prolonged fasting), with most clinical discussions on glucose dysregulation centering on the intestine, pancreas, liver, adipose tissue, and muscle…. More recently, however, the full significance of the kidneys’ contribution to glucose homeostasis, under both physiologic and pathologic conditions, has become well recognized, and is thought to involve functions well beyond glucose uptake and release. Besides the liver, the kidney is the only organ capable of generating sufficient glucose (gluconeogenesis) to release into the circulation, and it is also responsible for filtration and subsequent reabsorption or excretion of glucose…. These findings have provided considerable insight into the myriad of pathophysiologic mechanisms involved in the development of hyperglycemia and type 2 diabetes mellitus (T2DM) ….”  

The above is from AJMC at https://www.ajmc.com/view/ace005_12jan_triplitt_s11 and can probably use some explanation. First of all, AJMC is The American Journal of Managed Care and is actually for research outcomes. However, we find the information we need wherever we can. Let’s get to some of the explanations we may need. 

I started out by checking the glossary in What Is It and How Did I Get It? Early Stage Chronic Kidney Diseasethe first book I wrote about CKD way back in 2010. 

Glucose: The main sugar found in the blood. In diabetes, the body doesn’t adequately control natural and ingested sugar.” 

That helps, but we need more definitions. Thank goodness for my all-time favorite dictionary,The Merriam-Webster Dictionary: 

“acidosis: an abnormal condition characterized by reduced alkalinity of the blood and of the body tissues 

adipose tissue: connective tissue in which fat is stored and which has the cells distended by droplets of fat 

homeostasis: a relatively stable state of equilibrium or a tendency toward such a state between the different but interdependent elements or groups of elements of an organism, population, or group 

hyperglycemia: excess of sugar in the blood 

pathologic(al): … altered or caused by disease; also, indicative of disease 

pathophysiology: the physiology of abnormal states, specifically the functional changes that accompany a particular syndrome or disease 

physiologic(al): … characteristic of or appropriate to an organism’s healthy or normal functioning 

type 2 diabetes mellitus: a common form of diabetes mellitus that develops especially in adults and most often in obese individuals and that is characterized by hyperglycemia resulting from impaired insulin utilization coupled with the body’s inability to compensate with increased insulin production — called also non-insulin-dependent diabetes, non-insulin-dependent diabetes mellitus, type 2 diabetes mellitus” 

Can you hear me laughing? I’m beginning to feel like I’m back in the classroom teaching a vocabulary lesson. 

Okay, so what happens if we apply all these definitions to the AJMC quote? For one thing, the one that I found so surprising, we discover that the kidneys do generate glucose. Why is that so surprising, you ask. Well, if you’re like me, all you’ve known is that the kidneys regulate glucose. Hmmm, and how do they do that? 

According to Medscape.com at https://emedicine.medscape.com/article/983678-overview#a4

“Under normal circumstances, the kidney filters and reabsorbs 100% of glucose, approximately 180 g (1 mole) of glucose, each day. The glucose transporters expressed in the renal proximal tubule ensure that less than 0.5 g/day (range 0.03-0.3 g/d) is excreted in the urine of healthy adults. More water than glucose is reabsorbed resulting in an increase in the glucose concentration in the urine along the tubule. Consequently the affinity of the transporters for glucose along the tubule increases to allow for complete reabsorption of glucose from the urine.” 

I know, I know. We need to take a look at these tubules they talk about. That’s what Wikipedia is for. Take a look at https://bit.ly/3pqlF5k for more specific information. 

“The proximal tubule is the segment of the nephron in kidneys which begins from the renal pole of the Bowman’s capsule to the beginning of loop of Henle.” 

This goes back to basic kidney anatomy, but if you’re anything like me, you need a reminder every once in a while. Keep in mind, also, that ‘renal’ is another way of saying kidney. Rather than explain what the Bowman’s capsule and the loop of Henle are, I’ve included a good illustration above. So, the kidneys regulate the glucose in our blood just as they regulate waste products. 

Again and again, readers ask me questions to which I need to respond, “I’m not a doctor and have never claimed to be one. You really need to ask your nephrologist.” That’s the truth. When I write a blog about a topic – especially a reader requested topic – I’m learning, just as you are. 

Until next week, 

Keep living your life!  

Eating Makes Me Hungry

I couldn’t figure it out. I had my renal diet down pat (That only took ten years, she thought snidely.) When the foods I’m sensitive to had to be removed from that diet, I worked the new-reduced-possibilities-for-food-choices diet out pretty quickly, too. But then I noticed that I was hungry pretty much only after I ate.

I’d prefer to eat only if I’m hungry, but some of my medications require food first. Okay, so I knew I had to eat at least twice a day and graze several times during the day to keep my blood glucose level. I thought I took care of that by eating a small breakfast, lunch as my main meal when I got hungry, and a much smaller, almost snack type meal for dinner.

So why did eating make me hungry? Was I not taking enough food in? Nope. I counted calories to check and was not much under my allotted 1,200 per day. So what was it?

Women’s Health at https://www.womenshealthmag.com/food/g19920742/foods-that-make-you-hungrier/ named the following seven foods that make you hungrier:

  1. Whole wheat bread
  2. Fruit juices
  3. Egg whites
  4. Green smoothies
  5. Non-fact dairy
  6. Pickles
  7. Whole wheat crackers

Hmmm, between the renal diet and my food sensitivities I don’t eat any of these. Wait, I do eat whole eggs which contain egg whites, but I think Dr. Caspero meant only the whites for the purposes of this list.

Of course, I wanted to know why these foods make you hungrier. This quote is from the same article.

“For the most part, fat, fiber, and protein help with satiation,” says Alex Caspero, R.D. “So foods without those components will likely leave you searching for your next meal in no time.”

Reminder: R.D. means registered dietician.

I don’t eat whole wheat anything because I have sensitivity to it, but doesn’t it have fiber? That’s a yes and no answer. It does have fiber, but is more processed than regular flour which means less fiber. Fiber helps to fill you up. Side bar here:  Did you know that flour of any kind has wheat in it since it’s made from one or more of the three parts of the grain? That’s mean no bread for me.

Nope, Dr. Caspero didn’t answer my question as fully as I wanted it to be answered. Back to the drawing board, boys and girls.

Wait a minute. This from the BBC at http://www.bbc.co.uk/guides/zt22mp3 looks like it’s getting close to answering my question.

“Different types of food we eat affect the brain in various ways. For example, fatty foods trick the brain into believing that you have eaten fewer calories than you actually have, causing you to overeat. This is because fatty foods such as butter and fried foods contain a lot of densely packed energy.

However, other foods give a lasting sense of fullness. Fibre triggers the release of gut hormones that make you feel full. A low fibre diet though, with little or no wholemeal produce or fruit and vegetables, may leave you open to feelings of hunger.

Foods with a low GI (glycaemic index) such as nuts, vegetables and beans release energy more slowly than high GI food such as white bread and sugar. Eating more low GI foods will suppress your hunger by increasing levels of gut hormones that help you feel fuller for longer.”

Foods with a low GI, huh? This brings me back to the lessons from the Diabetes Nutritionist my family doctor sent me to when she discovered I was (and still am four years later) pre-diabetic. Okay, I can take a hint. What are some of these low GI foods?

The American Diabetes Association at http://www.diabetes.org/food-and-fitness/food/what-can-i-eat/understanding-carbohydrates/glycemic-index-and-diabetes.html  was able to help us out here:

“Low GI Foods (55 or less)

  • 100% stone-ground whole wheat or pumpernickel bread
  • Oatmeal (rolled or steel-cut), oat bran, muesli
  • Pasta, converted rice, barley, bulgar
  • Sweet potato, corn, yam, lima/butter beans, peas, legumes and lentils
  • Most fruits, non-starchy vegetables and carrots

Medium GI (56-69)

  • Whole wheat, rye and pita bread
  • Quick oats
  • Brown, wild or basmati rice, couscous

High GI (70 or more)

  • White bread or bagel
  • Corn flakes, puffed rice, bran flakes, instant oatmeal
  • Shortgrain white rice, rice pasta, macaroni and cheese from mix
  • Russet potato, pumpkin
  • Pretzels, rice cakes, popcorn, saltine crackers
  • melons and pineapple”

According the renal diet I follow, the Northern Arizona Council on Renal Nutrition Diet, I could eat all of these foods. According to my food sensitivities, I could only eat oatmeal, some fruits, and vegetables. Maybe that’s why eating makes me hungry.

Take a look at this. Redbook (and to think I smirked at my mom for reading this magazine when I was a teenager) at https://www.redbookmag.com/body/healthy-eating/g2819/foods-that-make-you-hungry/?slide=1 explains about fruit making you feel hungrier:

“’Fruit juice may already be on your no-go list, but if you’re eating more than one serving of the whole variety (i.e. one banana or one cup of berries), you may want to scale back. It may have nutritional benefits, but fruit is not going to help suppress your appetite,’ says Perlmutter. ‘It contains both fructose and glucose, which won’t signal insulin, causing your appetite to rage on.’”

Perlmutter is David Perlmutter, MD, a board-certified neurologist and author of Brain Maker.

Got it: More fiber, less sugar. Now the only question is can I get myself to adhere to that… and can you if you choose to stop being hungrier after eating than you were before.

Talking about magazines, Arizona Health and Living at https://issuu.com/arizonahealthandliving/docs/arizona_health_and_living_magazine__9a2d374f4dffc2 is helping me spread awareness of Chronic Kidney Disease. This is in their June 2018 issue.

 

Guess what I found when I was preparing my non-CKD book for last Thursday night’s reading at our local The Dog Eared Pages Used Book Store. You’re right. It’s a copy of the newly minted (um, printed) SlowItDownCKD 2017. Would you like it? All that I require is your address and that you haven’t received a free book from me before.

Random thought: I cannot believe I just chose a Father’s Day gift for my son-in-law’s first Father’s Day. Add my youngest’s upcoming nuptials and this is a very happy world I live in. Here’s hoping yours is a happy one, too.

Until next week,

Keep living your life!