Natural Management of CKD – With Adrian Harper
In today’s episode, we chat with Melbourne Naturopath, Adrian Harper. Adrian’s discusses his own health journey with Chronic Kidney Disease (CKD), and chats about all things CKD, from the pathophysiology to treatment choices, labs and more. In this podcast, Adrain touches on other complex disorders such as mould-related illness and CIRS.
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Andrew: This is Wellness by Designs. I’m Andrew Whitfield-Cook. Adrian Harper’s own journey with chronic kidney disease, CKD, has led him to be an expert in this area, supporting other patients, and also other complex illnesses like mould and CIRS. Welcome to Wellness by Designs. Adrian, how are going?
Adrian: Great. Thanks, Andrew, for participating with you today.
Andrew: Yeah. Good fun. Now let’s start with your personal history because this is obviously a long journey. I mean, you look fantastic, but you’ve had your issues throughout that journey, right?
Adrian’s CKD Journey
Adrian: Yeah. Correct. I was born with a congenital kidney disease, known as renal tubular acidosis, which is a fairly rare condition. And that causes my kidneys to become acidic and form stones. So I had some early signs when I was young, but I really didn’t have any major problems until I was 15 when I got a kidney stone and had to be hospitalized, and was going into acute renal failure because of occlusion of the stone through the ureters. So I really was at the point where I had to have a lot of investigations. I got a diagnosis and really explained a few of the early symptoms that I was experiencing as a child.
Andrew: Tell us about that pain, because it’s often said that it’s the only way that a male can experience labour pains. I mean, at 15 that would have been horrendous.
Adrian: Yeah. It was pretty scary to be going through at 15. And I’ve had kind of multiple signs since that episode. So the pain, particularly when it’s caught in the ureter and there’s a blockage, it’s definitely… There’s a lot of pressure that goes into the kidney and it’s a very, like, strong, sharp pain that really needs some pretty kind of like strong pain medications really to manage the pain. It’s just excruciating.
Andrew: But did it actually manage the pain? I’m told that even strong painkillers, you’re still pacing up and down the ward.
Adrian: Yeah, there’s definitely a level of pain meds in the first kind of like levels that you get generally don’t really cut it. And really it’s only until you get really heavily medicated I’ve found that the pain actually starts to subside, but you’re still feeling at that point of time. A lot of the medications just make you don’t care about the pain rather than not feel it.
Pathophysiology of CKD
Andrew: Right. Gotcha. Tell us a little bit more about the pathophysiology of chronic kidney disease. I know that there’s gonna be slight differences in the causation and the sequela from that, but the generalities of chronic kidney disease, what do you go through with regards to fatigue, etc. All that sort of thing.
Adrian: I guess, particularly in the early stages of chronic kidney disease, there’s really very minimal symptoms that people experience and it’s really common to the people to get diagnosed, not until they’re actually in late-stage renal failure when they’re starting to exhibit some of those So what you often find is that when the nephrons start getting damaged, normally it’s due to some top of the inflammatory process, then the other nephrons kind of up-regulate their function and kind of take over that. So you really don’t see much of a drop in kidney function until there’s a fair bit of damage. And when there is that fair amount of damage, then you start to see things like fatigue and calcium metabolism issues and acid-base balance issues and changes to electrolytes, particularly things like sodium and potassium that might then affect things like blood pressure as well. And then also flow onto things like fluid retention and edema.
Andrew: Okay. Also, you’re experiencing this in your growing years. So how did that affect, you know, normal development, things like that calcium metabolism? So even play, muscular, energy, so sports, you know, the fatigue would have been, I guess, you know, this total insidious cloud over you. So how did you cope with that through your formative years?
Adrian: So I was pretty healthy at a young age, I wasn’t really impacted apart from when I was having acute stone events. When I was having acute stone events, then I would be going into acute renal failure and getting a lot of those symptoms then, but then once the stone then cleared, then generally I recovered, kidney function returned to normal, and I was kind of active during sports, kind of living kind of pretty normally day-to-day. So it was really acute events that were really impacting me, but I had about four or five different surgeries kind of under 20 years of age. So every time I went in a surgery, that definitely kind of impacted me a fair bit.
Andrew: Yeah. But also, you know, academic you know, performance because you’re missing classes, things like that. So with regards to your peers, like, were you always in a phase of catch-up academically at school?
Adrian: There were, like, I guess, during points I was, so I’d have those kinds of crashes and have to be hospitalized and I’d play catch up. And a lot of the time I was doing a bit of work in hospital or at home as well, but it really didn’t make that kind of significant impact. I found kind of in the overall scheme of things I kind of managed to get all my schoolwork done. And yeah, I was very kind of focused on studies at the same time, but it did mean that I kind of… I was a rower at the time and I kind of dropped that because I just couldn’t keep up kind of the capacity with that. So it did impact, but study-wise not so much.
Treatments for CKD
Andrew: Gotcha. And tell us a little bit further about your medical treatments. What sort of medications were used, and were you in any way attracted to natural medicine or exposed to natural medicines during those earlier years?
Adrian: Yeah. So when I got my diagnosis at 15, I saw a kidney specialist after that, I’d been prescribed… Interestingly, the main thing I got prescribed was potassium citrate by the nephrologist. And that was really the only intervention besides surgery that I initially had. And the potassium citrate was really just correcting the acidosis and reducing stone formation. But then I saw a dietician as well and was really just recommended to remove salt from my diet through that process. So I still really had a lot of questions, I mean, how to manage my health that I didn’t really get through the medical system. So that’s when I started looking more into, particularly in nutrition because I’d come across a little bit of information about oxalates and particular foods, how they might kind of increase the risk of kidney stones. So I’d kind of went from there, this curiosity around how I could potentially find ways to manage my own health.
Andrew: This is something that interests me though, is how come you thought about searching for things like oxalates? Why doesn’t every patient think, is this all there is? You know, why don’t most people search rather than only a few people search? This is what’s… It’s really interesting to me.
Adrian: I think it’s largely, too because people say that the specialist tells them that there’s nothing they can do about that besides the medical intervention. And so they just believe that and they don’t look beyond that. Even, you know, for me seeing a dietician, I would have thought maybe a dietician might talk about oxalates, but really they just talked about sodium and, yeah, just made some suggestions around that mainly. So I really felt like there was so much more that I could do beyond that, just from even just a little reading I’d done myself.
Andrew: It’s interesting now, and I guess this is after the fact, but I was involved with liaising with a group at PA Hospital in Brisbane. And I’ll do a shout out to the dietician now, Dr. Megan Rossi and Dr… I think now professor, Katrina Campbell and they were looking at…could probiotics or fibre…fructooligosaccharides. Forgive me. So fructooligosaccharides, could they ameliorate this toxic metabolite seen in chronic kidney disease patients in the gut, which affected cardiovascular health? So it’s this sort of segue around the body. Did you ever find anything around that in your earliest searches? Because the earliest I’ve ever found p-Cresol… Forgive me, this is one of the metabolites. The earliest I’ve found p-Cresol mentioned was in a paper by…I can’t remember her first name, Loza Pony, talking about the garden of the gut, and they were talking about it with regards to paracetamol use. So did you find anything about these metabolites and how they were important to health early on? I mean, we now know about a few.
Adrian: No, not really because it’s not an area I was really, I guess, looking at initially. I was really focused more around stone formation and kind of acid-base balance rather than renal failure, because kind of at that stage I had pretty good kidney function in general still. So it wasn’t really until my, you know, kidney function deteriorated, then I really started to kind of look at this kind of uremic kind of toxins that are produced by the gut that play such a big role in kind of particularly later stage CKD.
Andrew: Right. And was that when you started to look at natural therapies or had you already gone along this journey?
Adrian: I’d already gone along that journey. So it was really just about…
Andrew: Okay. Tell us a little bit about… Forgive me, sorry for interjecting. Tell us a little bit about that timeline from your earlier investigations to when you got interested in actually pursuing natural medicine.
Adrian: Yes. So when I finished high school, I went down to the Conservatorium and studied classical music and it was there that I started the music therapy stream and I was doing some observations at the Royal Children’s Hospital with the practitioner, and it really got me kind of engaged in health a bit further and made me really understand that that was an area that I wanted to be kind of more involved in and potentially working with. So I didn’t end up finishing the music therapy degree, but it put me on the initial track. And then I actually ended up studying to be a chef and worked as a chef for five years. Basically due to my interest in food and nutrition, I thought that was a good way to go, but I ended up yeah, in the chefing industry, which was very stressful, long hours, not really focused on good quality food a lot of the time and definitely not focused on good nutrition.
So then I kept having some stone events and had a pretty big health crash when I was 22, which made me really realize that I needed to find some ways to manage my own health because I really wasn’t getting a lot of support from the medical model besides acute interventions, which were really crucial. But in between then, there wasn’t really anything kind of directing me to not having this kind of further acute events. So then I enrolled in naturopathy, or I enrolled in the kind of just the nutrition subjects first and that really resonated. So I went into the full naturopathy degree when I was about 25 and kind of went from there.
Andrew: Okay. So we’ve got to backtrack there because you became a chef, but you had a crap diet. Hang on mate. Why is that? Like, I thought you would have been making these gourmet dishes for yourself that were, you know, purpose-built, bespoke things for chronic kidney disease, not so?
Adrian: I was making pretty healthy food, like, pretty healthy food for myself most of the time. It was just in a work context, I wasn’t making very healthy food for everybody else, so that was.
Andrew: Gotcha. Okay. So you finished your naturopathy degree. And obviously, during this time, I’m gonna guess that despite, you know, legal obligation not to practice until you go into clinic, did you ever try anything earlier on? Did you ever, sort of, you know, start to get interested in, like, herbal medicine and what their function might be with chronic kidney disease?
Adrian: Yeah. I was always very interested in experimenting with various things. Even before I started studying naturopathy, I had a good friend that was studying herbal medicine, so she kind of gave me some suggestions as well, and that kind of got me interested in trialling a few things as well. Particularly for the stone management, I was using various things. Because, in terms of research, there’s a bit of research around stones for various natural medicines compared to other kind of kidney presentations. So, yeah, definitely I tried a lot of things.
Andrew: So let’s delve into those, and we’re not suggesting a treatment for chronic kidney disease here. That’s obviously got to be discussed with your own practitioner. But can we go over a few things that you found useful in your management?
Adrian: Yeah. Look, I think in terms of what’s important to stress with chronic kidney disease is that there’s a whole range of different presentations with it. So what works for one person may not work for another. It’s really about understanding the underlying drivers that are causing the kidney dysfunction. So I find particularly with a lot of the kind of traditional prescribing around kidney health, a lot of it’s around diuretics and things that push fluids for the kidneys, and from my experience that doesn’t really do much. And in a lot of contexts, particularly when the kidneys inflamed, it actually just puts more pressure on the kidneys and actually and it’s caused pain in the kidneys because it’s just putting too much pressure through. So really it’s about a whole range of things that you probably wouldn’t be necessarily considering for kidney disease that I find useful. And also things that have a really high safety profile as well, because obviously there are some components that have nephrotoxic effects. And so that’s something to be really cautious of too when kind of using any kind of natural substance with chronic kidney patients.
Herbal Medicine and CKD
Andrew: Gotcha. So what about Chinese medicines? You know, we’re taught verily…stupid word. We are taught very commonly the Western herbal medicines for the kidney support, you know, the Zea Mays, things like that. And now probably since the early 2000s, we’ve been introduced to one of the Ayurvedic herbs, Crateva nurvala, but there’s a whole host of the Chinese medicines, you know, red sage…I’ve got palpartum on my brain. Forgive me, rhubarb. How do these function? Do you find that these have a positive effect with chronic disease, any disease in stabilizing the tissues of the kidney? Or do you find that we’ve got to be really cautious of a few? Can you detail a few of those? So we’ve got an aspect of, you know…what do you call them…therapeutic options and certainly cautions and contraindications.
Adrian: Yeah, I think particularly, it’s really about looking at risk. And I often approach things, I guess, in a fairly similar manner to prescribing, I guess in pregnancy and particularly Kerry Bone’s got a fairly good hierarchy of herbs used in pregnancy and based on the level of evidence. And I kind of apply that with kidney patients as well. So generally what you’ll find is there’s quite a number of Chinese herbs that have, you know, a reasonable level of evidence that have been used in chronic kidney failure. So with those, I definitely think they have a fairly reasonable safety profile because they have actually been used in studies. And I think that’s the thing too, is a lot of the research around chronic kidney disease is coming out of China. So the evidence for herbal medicine is often on a lot of Chinese herbs, but then it’s really looking at other levels as well of herbs that, you know, there’s at least in animal studies or in vitro studies that suggest that it should actually not be kind of toxic to the kidneys, and then staying away from any herbs that have any type of nephrotoxicity, any evidence about… Even, like, case reports of kidney kind of toxicity with particular herbs, I tend to stay clear of.
And then also then looking at what’s been used traditionally, in traditional prescribing and apply that as well. So I definitely find some of the Chinese herbs such as Astragalus and Rehmannia and Dan shen really useful in chronic kidney disease and particularly some of the medicinal mushrooms like reishi and cordyceps. Also, I’ve got some really great results with those. But it’s really
Andrew: Sorry to cut you off
Adrian: That’s okay. Yeah. And it’s just really looking at quite a few things that are outside the box as well. So from my perspective, I’ve got, I guess, a whole range of different herbal categories that I kind of apply to different functions and effects I want in the kidney or kind of in the system in relation to kidney disease. So I do find that the herbal medicine that we got taught around kidneys was not really the right approach and really had to kind of develop my own herbal prescribing approach to kind of address that.
Medicinal Mushrooms and CKD
Andrew: Okay. I’m very interested in the medicinal mushrooms, always interested in medicinal mushrooms. Can you give us a few… You said cordyceps, was it reishi?
Adrian: Cordyceps and reishi are probably the main mushrooms I tend to use. And definitely, I’ve had some great results with both of them. Reishi I’ve used the proteinuria with quite a lot of success, particularly in relation to kind of using with other herbs. Particularly cordyceps, I feel very safe with because it’s been used in kind of some studies with transplant as well, kidney transplant. So I wanted only herbs that has some kind of safety data around kidney transplant and actually showed that it improved outcomes of kidney transplants. So…
Andrew: And it doesn’t interfere with immunosuppressive drugs then.
Andrew: That’s great to know. That’s really an opener.
Adrian: Yeah, because I do see a few transplant patients and these patients obviously have a lot of caution around prescribing, and I generally don’t prescribe any type of herbal medicine with transplant patients because you just don’t really understand what the effect is gonna be. And if they lose a kidney yeah, it’s just…I’ve seen people actually lose kidneys for other reasons, for stopping their medication. And it’s just a scenario you don’t want to happen.
Dietary interventions and CKD
Andrew: Absolutely. What about dietary intervention? You’re a trained chef. So obviously, you’re going to be giving a lot more finesse to the food prescriptions, the food advice that you give your patients, let’s delve into that a little bit. How do you get patients on board? You know, not every patient is gonna be as healthy looking as you, nor as sporty, particularly chronic kidney disease. They’ve often ended up there because of a lifetime of renal abuse. So how do you get them on board with dietary modification?
Adrian: Well, it really depends on the level of kidney function as a starting point. I think people that have, like, minimal loss of function, the early stages, they generally have a bit more motivation. They’re often a bit more worried when they start to notice their kidney function is dropping. So they’re pretty happy to make kind of those changes because they don’t wanna see it drop any further. When you get someone that’s heading towards end-stage renal failure, it’s a little bit of a snowball effect where it’s pretty hard to really slow things down at that stage. It’s often a range of different lifestyles and other complications driving the issue, and the diet might be something that’s a lot harder to get people on board with, but at the same time, the diet is…particularly with the latest stage renal failure, the diet is probably the crucial thing that really makes such a big difference and particularly to kind of quality of life and day-to-day symptoms.
So that definitely is something that is, I guess, really important to be kind of shifting because there’s not much point using kind of supplements if they’ve got a diet that’s kind of contributing to uremia. And what I do find too is at the later stage of renal failure, you really need to develop diets based on the pathology and what’s happening, particularly with things like the electrolytes. And everybody has a bit of a different presentation at that stage. So generally, what I find is that you need to have a fairly individualized diet in that context.
Labs in different stages of CKD
Andrew: Gotcha. Can we discuss a little bit about the pathology? You know, I’m not asking for exact levels and things like that, but when you’re talking about the different stages of kidney failure and then you go into end-stage renal failure, where people, you know, are really looking at…I’ve got osmosis on the brain, you know, the wrist….exchanging solutes through the…Dialysis. Damn. It’s early in the morning, everybody. So can you take us a little bit through the labs that people experience at the different stages of kidney failure? What are we looking at with like, you know, EGFR with your different electrolytes, what goes wrong? What do medicos look at, and what don’t they look at that maybe we should?
Adrian: So generally I find, particularly in the early stages, you’re often just seeing some alterations to creatinine clearance, maybe particularly also like protein in the urine, so proteinuria on a urine sample. There’s maybe not a lot of other changes. Sometimes there’re some changes to complement at those early stages that can give you an indication of what’s the underlying kind of issue with the kidney as well. But it’s not really until you get to the later stages, particularly stage four, where you really start to see a fair bit of alteration in terms of some of the pathology markers. So you’ll see kind of fairly increases in urea and creatinine and then also the electrolytes may start becoming altered then. So often kind of potassium clearance reduces, sodium might get retained, phosphate will tend to increase, which will then start to kind of impact too on calcium metabolism.
So you often then start to see PTH, parathyroid hormone increase. It’s really common to see ESR increase at that stage as well. So there’s a range of things in particular at stage four that you start to see that also then is kind of impacting on symptoms. But, yeah, what I also find is that the gut’s playing such a key role and that’s something that nephrologists don’t look at, at all. And I do think that that plays such a key role in how kidney disease progresses, and also particularly how things like cardiovascular disease progresses as well, which is a common comorbidity with CKD.
Andrew: Yeah. I was thinking about that potassium. You’ve also got magnesium, which very often isn’t measured. They measure that with calcium, potassium, sodium, your CCK, your ESR, your glomerular filtration rate EGFR. But when do these symptoms tend to occur? I know you just said at the later stage, but for instance, earlier on in your journey, did you ever experience any…we know about fatigue, but any, for instance, ectopic beats or rises in blood pressure or even dependent edema in the ankles, were any of these signs evident earlier on?
Adrian: No. The only thing that I really had was low platelets. So I’ve always had low platelets from early on. But, yeah, besides that, I really had very minimal symptoms, even when my GFR got down to about 22 and even when it was at 22, I was having, like, very minimal symptoms. So it wasn’t kinda until I ended up at end-stage renal failure that I really developed some symptoms.
Andrew: Like, I’ve never heard of these being measured outside of a lab, but things like TMAO trimethyl amino oxide and certainly lipopolysaccharide, have you ever looked into… Obviously, we tend to want to modulate these with diet and maybe some microbiota change or some probiotics, but have you ever come across any monitoring of these markers?
Adrian: No. But what you can like… So what you’ll find with the markers is… So urea and creatinine are the main markers that are used for monitoring kind of kidney function, and GFR is just a calculation from those markers, really. But what you’ll actually find is that the urea and creatinine don’t actually drive a lot of the, like, kind of pathophysiology. It’s actually kind of like other uremic toxins, like p-Cresol sulfate, indoxyl sulfate, and the TMAOs that tend to be driving a lot of the dysfunction. So you can generally gauge that if urea and creatinine are high, that those uremic toxins will be kind of increasing as well.
Andrew: Gotcha. Okay. So what about modulation of these? Have you found, for instance, that dietary, or maybe probiotic intervention, maybe the fructooligosaccharide, something like that, and you can measure the decrease in these markers, which are indicative of the surrogate markers of TMAO and indoxyl sulfate, things like that. Have you seen these pathology markers decrease with just dietary modification?
Adrian: Yeah, definitely. And that’s something that I just experienced myself kind of day-to-day kind of managing my own health. So particularly when there’s, like, late-stage renal failure without the capacity to recover function, really, I think the treatment needs to be kind of geared around enabling the body to actually clear these uremic toxins. And, well, there’s two ways to do it, to make sure that the body’s not producing so many uremic toxins, but then also enhance the clearance as well. So they’re probably the two main focuses and that can be done through a range of different kind of approaches.
Andrew: Yeah. And you were mentioning there about non-recoverable renal function, at what level can you just not recover renal function? Are we talking stage four?
Adrian: No, I think… I can’t really comment on that because I’ve been in stage five renal failure and recovered. But it just…but, like now I’m kind of back in stage five. But it really just depends on the level of damage in the kidneys, and particularly whether it’s a really chronic damage or if there’s acute damage and more capacity to…kind of for the kidneys to bounce back as well. So I have seen people be able to improve function, but really a lot of the time it’s more focused on retaining what little function they have left.
Lifestyle Interventions in CKD
Andrew: Gotcha. Now we have to also comment, obviously, about lifestyle. So sleep, exercise, how important are these in maintaining healthy renal function or at least, right, retaining some renal function?
Adrian: Yeah, I definitely like sleep. There’s a bit of research around melatonin and sleep and the impact on kidney function. Also, I think particularly in relation to how it impacts the gut, is quite important. Exercise definitely is gonna help with things like circulation to the kidneys as well and bone density and a whole range of other things. So, you know, I think all those lifestyle approaches are pretty important. It just really depends on what level of function you’re addressing, too, because you have to be really careful with exercise in later kind of stages, too, because you end up kind of like driving up a lot of the creatinine and kind of uremic toxins if you kinda do too stronger exercise as well.
Contraindications in CKD
Andrew: Gotcha. Okay. That’s really a good point. Thank you. And what about any major contraindications that we’ve really just got to be aware of? You were saying that, you know, you weren’t necessarily happy with the way that kidney health, if you like, was taught in college. Is there anything that we really need to about-face, we really need to reconsider what we learnt and change it?
Adrian: Well, I think it’s more a case that we just didn’t learn anything, really, because…in terms of the…I was, like, really excited at third year to actually get in and have the kidney class. And we got in there and they basically said to us, “Kidneys are too complicated, don’t treat them.” And we just talked a bit about kidney stones and UTIs, and that was about it. So I was pretty disillusioned after that because I was like, “I’ve spent several years studying and I’ve still got no answers to the questions I had.” So that’s really when I went off on my own and did kind of my own research and actually realized there was a lot you could do. So, yeah, there’s definitely a whole range of things that I would avoid using in kidney disease.
And some of it will depend on the level of function as well, particularly at the later stages. You need to be really careful that you’re not giving any supplements that will be driving up uremic toxins, like p-Cresol sulfate, and kind of driving up TMAOs. Particularly around things like any amino acid supplements, will do that. And then fat-soluble vitamins can sometimes be a bit of an issue because they can kind of buildup and not be cleared, particularly vitamin A, there’s a whole range of herbs that I would be staying away from. And…
Andrew: Such as what?
Adrian: Yeah, such as what? I would be very cautious about any strong anti-microbial herbs that may actually kind of drive up inflammation through the release of LPS because that might…I’ve actually seen that with other patients, you know, get some kinda like renal inflammation from going through other types of…particularly where they’ve kind of done some type of protocol on their own that they’ve kind of like read about and taken say, like, oregano oil. A lot of people just go out and take oregano oil, but I’ve actually seen that kind of drive up kind of kidney damage. So if they have a heavy kind of place with LPS, so things like that. You know, there’s a whole range of herbs that have been discussed in medical journals, particularly nephrology journals around their nephrotoxicity.
So there’s a very famous case that happened in about…I think the 80s known as the Belgian slimming disaster, where there was a weight loss product that had aristolochic acid in it and it caused a number of women to have kidney failure from taking it. So that’s a story that every nephrologist has heard. And so that makes them very cautious about any type of herbal medicine. But I think it’s also important to kind of understand that there’s so many different things that can cause damage to the kidneys. There’s so many pharmaceutical drugs as well, and there’s a lot more cases of pharmaceutical drugs damaging kidneys than herbs. I think the difficulty with herbal medicine too, is the quality of the herbs. So definitely, there’s issues with substitution with toxic herbs or contamination with chemicals and heavy metals that might damage the kidney. So it’s really…you need to kind of be using suppliers that you’re really sure about the quality and they’re independently testing herbs and things like that to make sure you’re getting the right product.
Mould Illness, CIRS and CKD
Andrew: Good advice. Now, Adrian, over time, you’ve also specialized in mould illnesses and CIRS. Do you see any parallels between perhaps your management of chronic kidney disease and your therapeutic interventions with mould and CIRS?
Adrian: Yeah, definitely. So I’ve been working with CIRS patients for probably about seven years or so. I was working at an integrative medical clinic before my current practice, and we saw a lot of CIRS patients. And I really started to see a lot of parallels, particularly with late-stage CKD and CIRS. Essentially, they’re both conditions where the body has an inability to clear toxins and metabolic wastes and that, like, systemic inflammation arises. So we often see very similar systemic inflammation happening with kind of end-stage renal failure to CIRS as well. And so I guess that kind of… And then you also see, you know, obviously gut changes with, like, mycotoxins will kind of drive dysbiosis as well uremia and then that will kind of drive further LPS and other toxic metabolites from the gut to be causing leaky gut and immune activation and then driving the kind of systemic inflammation. So, I definitely saw a lot of parallels and I actually saw a lot of parallels in treatment as well, and kind of aiding the body to kind of get rid of these types of kind of components as well.
Probiotics, and Prebiotics in CIRS and CKD
Andrew: Do you find that all probiotics are of use and are safe or are you sometimes cautious about certain types? You know, we’ve seen the D-lactate free formulations and, you know, there’s been some concern about that with… Medically, it’s really short bowel syndrome. Some people have extrapolated a little bit more than what the research says, but do you ever find any correlations with different species have different actions?
Adrian: Yeah, I definitely will kind of like focus on kind of like evidence-based strains of probiotics. But generally, I don’t use a heap of probiotics. I actually prefer to use prebiotics rather than probiotics. I’ve actually just found they’re general, like, particularly for renal failure, they’re more effective, but also with CIRS, I often find, yeah, a lot of the prebiotics actually helped to kind of clear, kind of mycotoxins and metabolic waste through the gut.
Andrew: Gotcha. What sort of prebiotics do you favour?
Adrian: So for renal failure, there’s a whole range of prebiotics that have some kind of evidence, acacia fibre and partially hydrolyzed guar gum have both been studied in kind of CKD, things like inulin have lactulose. So, yeah, I think most of the prebiotics actually that are available, there’s some kind of limited research for their use. And it’s interesting when you look at some of the… Like there’s some studies around acacia fibre and using that as an alternative to dialysis. But when you’re looking at the amount that they’re using, it’s huge amounts compared to what we’d probably normally prescribe in a gut context. So it’s also just about whether the patient can, you know, tolerate that much prebiotic fibre going through their bowel. But definitely, from my experience, one of the key things is to get as much kind of prebiotic fibres through the bowel to kind of be binding and also using binders in renal failure as well because binders, which I use a lot for CIRS, will help to kind of bind uremic toxins as well and help to clear them.
Binders in CKD
Andrew: Right. Any sort of binders that you prefer that you use, you know, kaol and things like that, or do use zeolite or what?
Adrian: So there’s some… If you look at the research, there is binders that have been used in a renal context. And so there’s things like zeolite because obviously that’s a good ammonia binding affinity, which ammonia is also a problem with renal failure. Things like bentonite clay have also been used, chitosan and even… Yeah, a few other things as well. Even just using like calcium carbonate can often be a bit of a good binder for things like, phosphorus as well. So, yeah, generally I think… And then again, I guess also activated charcoal has been used as well. So it’s just about using them in the right place in the right way and making sure that the patient’s tolerating them. But they can quite useful. Some of them, particularly the bentonite clay, it’s a phosphate binder as well.
Andrew: Seems like you need to write a course. Where can practitioners find out more information because, obviously, this is a specialized area and there’s a heap of responsibility associated with it. So where can practitioners learn more about responsible care for their patients that’s obviously not taught in college?
Adrian: Yeah, it’s a difficult question because there’s really not a lot of resources. I guess from my own clinical practice, I’ve really just learned from my own experience and particularly I’ve been managing end-stage renal failure for the last six years after I had an allergic reaction to an antibiotic. And I guess in that timeframe, it’s really made me understand how things kind of sit with the kidney and, like, the body in general with that level of kidney function, because I’ve got a pretty narrow kind of space to kind of work within. And as soon as I do something that’s kind of not quite working for my system, I know about it. So I think kind of having that knowledge. And then also I just read a lot of, like, scientific journal articles because really that’s where there’s some information around kind of herbs and other kind of natural medicines in kidney disease because we just don’t have a lot of information in our traditional texts.
Andrew: Adrian, there’s so much more that we could discuss, and you definitely need to be writing a course for practitioners to learn from. But thank you so much for taking us through at least some of the critical aspects of chronic kidney disease care with us today on Wellness by Designs. Thanks so much for joining us.
Adrian: No problem. Thanks for having me on, Andrew.
Andrew: And thank you too, to our listeners and our viewers for joining us and for your company today, you can find all the show notes and relevant references that we’ve referred to on designsforhealth.com.au. This is Wellness by Designs. I’m Andrew Whitfield-Cook.