Maintaining/Optimizing kidney health
First, thank you so much to you and your team for what you do. I have learned so much from you and it has all been “news you can use.” You commented in a podcast with Rick Johnson that you pay close attention to eGFR, citing a hypothetical 40 year old patient with an eGFR of 85, which you think is too low for that age. I am that patient in real life (actually mine is a little lower) and it raised several questions for me. I wonder if you might eventually do a deep dive on the kidney and kidney health—optimizing function and preventing disease. It seems like an under-discussed subject relative to its importance--it wasn't on my radar at all until your comment. My question wishlist starts with kidney function testing. e.g. Can you explain eGFR tests? How accurate are eGFR tests anyway? Is it like cholesterol testing where there are different equations, and what is the current thinking on best measures? Why do they use different metrics for different races? Are there alternative tests for kidney function, and if those look good would you be less worried about a lower eGFR? Are there other labs or screenings that you would consider relevant here? In terms of kidney health: what harms kidney function? It would be interesting to go wide on this—for example, if someone does NOT have the things Rick Johnson identified like high blood pressure / uric acid / insulin resistance, what are the other things that might be reducing eGFR? Other diseases or conditions, common medications like NSAIDs, ADHD stimulants, birth control, anti-depressants etc, or even certain compounds in drinking water (hard water v. soft water)? To what extent does alcohol hurt the kidney and any way to offset it if you like having a glass of wine or two with dinner? Is it possible to improve kidney function or is it "once it's gone, it's gone"? Could your hypothetical patient with an eGFR of 85 get it up to 90? If so, what are the things you would consider in order to craft advice for her? That's already a lot, but of course kidney stones and kidney cancer seem to impact a lot of people---anything on causes or prevention would be interesting. Thank you very much,
Healthy weight gain
There’s been an increasing interest in weight gain ‘diets’, especially among young active females experiencing loss of periods (hypothalamic amenorrhea). Would be interested to know if Peter had any views the best strategies for achieving a ‘metabolically healthy’ calorie surplus to promote weight gain?
Calcium intake, supplementation, ASCVD and osteoporosis
Could you share your thoughts on the research surrounding both calcium supplementation and general calcium intake (eg from dairy) and links to increased risks of ASCVD? I’m 41yr old female with a history of stress fractures (from running) and didn’t consume much calcium during my teens, twenties and thirties so have been focusing on increasing my daily intake. However, I also found out recently I have elevated Lp(a) levels so am concerned about anything that further increases the risk ASCVD. Equally I want to minimise my risk of fractures later in life due to osteoporosis. Not sure how to balance these two things out.