But if sometimes you won't even pop on a blood test until your kidney is, what, the function has been depleted by, you say, as much as 90%?

So at 90%, you will absolutely see the change, but you could lose 50% of your kidney function before you see a change.

But here's the problem.

The statement that I'm saying, and this applies to every test, The blood tests that we do are designed to see when the disease is actively going.

The blood test doesn't see the disease when you have all of this prevention you could do.

Take blood sugars, for example, and A1C.

What is a hemoglobin A1C? It's the sugar that attaches to a red blood cell, and the red blood cell's average lifespan is about 120 days.

Yeah.

Hmm.

If your weight has been higher, the weight itself can cause a disease called focal segmental glomerulosclerosis.

That's a mouthful.

It just means the pressure on the kidneys is causing more filtration that, once again, is taking a tight barrier and making it leaky.

So all of those things, diabetes, high blood pressure, and obesity, if you have those and you have a lot of soap suds...

And in other words, when you see foamy urine, it's not a one-time occurrence.

You know, if you ate a lot of protein, that could do it, or other things could do it, so that doesn't necessarily mean.

Hmm.

I wanna bring in our physician, Dr. Hashmi, so we can get a fuller picture of what a GLP-1 actually is and how it works to quiet food noise.

So food noise is so important to understand.

In MRI scans, if let's say I'm somebody who's dealing with this disease, obesity, and you're not, and we do an MRI of both of our brains, you'll find that just looking at, let's say, something sugary, let's say it's a donut, just looking at it, you'll see my brain light up far more than yours.

It's a crazy concept.

So food noise is a medical condition.

It is not a psychological condition that's just in your head.

It is real to our patients.

Do I need to take it once a week forever or can I mix it up and do it every two weeks or do I take a lower dose every couple days? Like what's the current recommendation for maintenance phase?

But, you know, I think it would be helpful maybe just to set the stage, since you're board certified in obesity medicine, to just help people understand what are GLP-1s, help people understand GLP-1 receptors in our body, and what these drugs were designed to do.

Sure.

So the first question, what the heck are GLP-1s? Well, GLP-1s, they're nothing more than peptides.

And peptides are these small amino acids which really act as chemical messengers telling different cells on what to do.

That's that simple.

And GLP-1 receptors are found everywhere in the body.

In fact, every week we find they're found in one new place.

Since you brought it up, let's dive into the side effects.

Is this an approach you would recommend for these things?

Unfortunately, the short answer to that is no.

There isn't enough data out there to support a prolonged water-only fast.

Because of the medications that most of our kidney patients are on, any sort of attempt at dehydration can actually cause worsening kidney functions.

Remember, medications like ACE inhibitors, ARBs, SGLT2s, all of them are acting in a way that it can actually exacerbate any effects of dehydration you feel.

Now, flip that around to looking at the different forms of fasting.

Just because a little bit of something is good doesn't mean overdoing it is going to be great.

Hashmi, do you want to start, then Robbie, then Cyrus?

And from a kidney point of view, where do you stand on this?

When it comes to kidneys, this is where I think if you put 10 experts in a room and you had to change a light bulb, the light bulb would end up never getting changed.

That's the problem with nowadays is when we ask these questions, we're trying to show how one person is smarter than the other.

And that just depends on how popular they are and how much social media and what they've done.

So I don't believe in any of those things.

What I can tell you is the data around kidney disease is very, very simple.

What the data shows is that the more salt you add to your diet, the more your blood vessels do end up getting stiff.

So if you're looking for a number to be like, okay, I'm just not going to exceed that much sodium could be a good guideline, but certainly just, you know, working with a doctor you trust is the best way forward for your optimal health outcomes.

And

it's been a long time since we connected.

So this is great to see you guys.

For my last 10 years, my base has always been kidneys and I started in kidneys.

Gosh, now.

for two decades or so and change.

But then I got involved in the obesity aspects.

It's the same approach, which is what are we going to do to make insulin work more efficiently? And it's a beautiful system and it absolutely works.