Lupus & Autoimmune disorder plan of attack
Hi - I was diagnosed with lupus at a young age (25) and 10 years into the diagnosis I am very concerned about the long-term impacts of the medication required to keep it under control. I am currently off of Imuran but still require hydroxychloroquine and prednisone as part of my treatment plan. What would be your recommended dietary, supplemental, and lifestyle interventions to deal with lupus and is there anything to help protect against long-term effects of the medications? Additionally, one of my flare causes is photosensitivity and my quality of life would improve drastically if I could address that one item - curious if there have been any studies which would support interventions for photosensitivity causing flares in lupus patients.
Egfr
It was just brought to my attention that my egfr is low (58) by a HRT doc. So I went back and looked at results from years ago. My values have been from 52-59 for the last 8 years. No one has ever said anything to me! Creatinine runs highish around 1.1, BUN is high 1/2 the time. I’m a 53yo fairly healthy female with lower BP. Interstitial cystitis. I did have unroofing surgery for a myocardial bridge after years of symptoms (now I’m cardio perfect!) Would love to hear a podcast about kidney function!
Buteyko Breathing — evidence and mechanisms
Hi Peter, I was recently referred by several on my care team (doctor, dentist, and yoga therapist) to the Buteyko Breathing Technique as something that could help with my sleep issues. It involves shallow, slow breathing and breath holds; the theory behind it apparently is that slower breathing acutely increases CO2 blood concentration which increases oxygen delivery to cells (via the Bohr effect), and repeated practice leads to metabolic compensation by the kidneys which (chronically) increases base excess and CO2 “tolerance” via blood pH increase. They argue that this leads to a range of physiological benefits, including lower RHR and BP and higher CR fitness, due to better oxygen delivery to cells. I have no training in medicine or biochemistry, but this sounds suspect to me. This metabolic compensation is what happened to me (supported by ABG test results) when I had untreated sleep apnea in the past, which caused a lot of very unpleasant symptoms. And, I can’t make sense of Buteyko’s argued mechanism (won’t CO2 be produced locally wherever there is oxygen demand, solving the problem naturally? How much better will higher ambient CO2 make things?). Are there other plausible reasons that shallow breathing can bring CR benefits? (For example, improving aerobic efficiency?) Another possibility is that most of the benefits come from stress reduction / parasympathetic activation, in which case other meditation techniques would be a viable substitute. Unfortunately I cannot find many studies on this, let alone peer-reviewed or with good controls (like, say, mindfulness meditation or TM), but one small one (Chaudhary et al. 2021, European Journal of Molecular & Clinical Medicine — not sure if legit) shows what seem to me to be remarkable effects on RHR and VO2max. So anyway it is hard to know, but just speaking on priors, does it sound like there is a plausible mechanism at work here?
Sex Differences Deep Dive - treating men versus women
Hi Peter and Bob, I was hoping to get your thoughts on the biology of sex differences. More specifically: - What are the differences in Peters's "framework" when treating either patient either a male or female patient? - What are the differences in how men and women respond to different treatments (e.g. statins, metformin, anti-depressants)? - What diseases are more prevalent in either men or women? and why? (e.g. women are at a much higher risk of Alzheimer's disease). - Other cool sex differences facts you know about - for example - Ethan Weiss talked about sex differences in GH and clotting. I would love to hear your thoughts on these questions. Big fan! Thanks.