Heart and Kidney Diseases and Type 2 Diabetes May Be One Ailment(scientificamerican.com)
scientificamerican.com
Heart and Kidney Diseases and Type 2 Diabetes May Be One Ailment
https://www.scientificamerican.com/article/heart-and-kidney-diseases-plus-type-2-diabetes-may-be-one-illness-treatable/
48 comments
There is an alternative possibility: you start out with a metabolic disorder, that will eventually grow into diabetes. Along the way, it will make you obese and cause (directly or indirectly) heart and kidney problems.
Unfortunately, since Ozempic treats diabetes with or without obesity, and it also treats obesity without diabetes, it won't help us figure out if obseisty is a cause or a side effect of diabetes. But there really is little reason to pretend it's clear either way.
Unfortunately, since Ozempic treats diabetes with or without obesity, and it also treats obesity without diabetes, it won't help us figure out if obseisty is a cause or a side effect of diabetes. But there really is little reason to pretend it's clear either way.
History is a pretty strong indication that it’s clear to me.
I find it exceptionally hard to believe populations at scale went from relatively “normal” weights to obese as the majority due to an emerging novel metabolic disorder. All within 1 to 2 generations.
Much simpler explanation is that diets and lifestyles changed leading towards obesity. Whether or not a metabolic disorder happened somewhere in the middle there seems irrelevant to me. It’s very clear to me that obesity causes the issues and not the other way around.
I’m open to thinking differently about it, I just find the evidence uncompelling as someone who was obese the majority of my adult life. Given the unique circumstances of how I grew up and then later experienced life, I’m quite confident obesity is primarily caused by lifestyle. Put simply - put yourself in a situation where obesity becomes easy to achieve and the majority of people will become obese.
Humans being what they are will of course have myriad of outliers to refute the point, but outliers are uninteresting to discuss in this context.
I find it exceptionally hard to believe populations at scale went from relatively “normal” weights to obese as the majority due to an emerging novel metabolic disorder. All within 1 to 2 generations.
Much simpler explanation is that diets and lifestyles changed leading towards obesity. Whether or not a metabolic disorder happened somewhere in the middle there seems irrelevant to me. It’s very clear to me that obesity causes the issues and not the other way around.
I’m open to thinking differently about it, I just find the evidence uncompelling as someone who was obese the majority of my adult life. Given the unique circumstances of how I grew up and then later experienced life, I’m quite confident obesity is primarily caused by lifestyle. Put simply - put yourself in a situation where obesity becomes easy to achieve and the majority of people will become obese.
Humans being what they are will of course have myriad of outliers to refute the point, but outliers are uninteresting to discuss in this context.
The problem with this line is that there are populations that live very similar lifestyles but have massively different obesity rates. The rate on obesity in Tonga is much larger than the one in the USA, which is itself much larger than France - and yet all three are modern industrialized nations where the vast majority of the population lead mostly sedentary lifestyles.
Even within these places, there are often huge disparities in obesity rate. For example, Colorado has half the rate of obesity as the USA: are people in Colorado leading such hugely different lives from the rest of the nation? And are people in Colorado leading lifestyles more similar to those in California than those in Kentucky?
To me, the much more plausible explanation is that there is some aspect of modern life (most likely some element in our food, but very possibly in our enviroment as well) that is causing metabolic issues that lead to this huge increase in appetite that in turn leads almost inexorably to obesity.
Even within these places, there are often huge disparities in obesity rate. For example, Colorado has half the rate of obesity as the USA: are people in Colorado leading such hugely different lives from the rest of the nation? And are people in Colorado leading lifestyles more similar to those in California than those in Kentucky?
To me, the much more plausible explanation is that there is some aspect of modern life (most likely some element in our food, but very possibly in our enviroment as well) that is causing metabolic issues that lead to this huge increase in appetite that in turn leads almost inexorably to obesity.
Does altitude have an effect?
> are people in Colorado leading such hugely different lives from the rest of the nation?
Yes, absolutely. I've spent time in very obese locations in the midwest, and spent time living in Colorado and have relatives there.
The lifestyle differences are exceedingly stark. Drastic even. It's clowned on for the hippie/health conspiracy nutjobs meme for a reason. You immediately realize why people look different.
> And are people in Colorado leading lifestyles more similar to those in California than those in Kentucky?
Yup. Again, this is obvious simply from spending time in both locations. You will find places in CA that are nearly as obese as many places in KY, and find that the lifestyles look quite similar between the two. Louisville lifestyle is quite similar to Bakersfield for example and the obesity rate just so happens to coincide with that observation.
I don't know enough about Tonga vs. France to comment, but I imagine if you spent a few months living within the populations of both and living a typical lifestyle/eating a typical diet you'd likely find immediately obvious differences. In this case, genetics is also a very plausible front-line explanation - where in western countries it simply is not due to similar demographics changing so drastically over a generation or two while removing the immigration confounder.
> To me, the much more plausible explanation is that there is some aspect of modern life
Yeah, it's the diet combined with a relatively fast switch to sedentary lifestyles. Mostly the diet and food environment. Participation in adult casual sporting leagues and other outdoor activities is right behind it. Changes in the average activity levels while at work. Just 12,000 steps a day makes a drastic difference in weight for many people.
Technology plays a major role - screen time went from minutes a day to double-digit hours for the majority of the population. Hard to be active while staring at a screen of any sort.
Like I said - I'm also open to some environmental variable not explained by much simpler facts like the food environment, but I think that's exceedingly less likely than what is smack dab obviously right in front of our faces that for some reason we ignore in pursuit of near-conspiracy level stuff. The obvious thing usually ends up being true, and I see no reason in this case to believe otherwise.
Again though - exceptions abound. Humans are complex creatures. They average out quite well though at population scale.
Yes, absolutely. I've spent time in very obese locations in the midwest, and spent time living in Colorado and have relatives there.
The lifestyle differences are exceedingly stark. Drastic even. It's clowned on for the hippie/health conspiracy nutjobs meme for a reason. You immediately realize why people look different.
> And are people in Colorado leading lifestyles more similar to those in California than those in Kentucky?
Yup. Again, this is obvious simply from spending time in both locations. You will find places in CA that are nearly as obese as many places in KY, and find that the lifestyles look quite similar between the two. Louisville lifestyle is quite similar to Bakersfield for example and the obesity rate just so happens to coincide with that observation.
I don't know enough about Tonga vs. France to comment, but I imagine if you spent a few months living within the populations of both and living a typical lifestyle/eating a typical diet you'd likely find immediately obvious differences. In this case, genetics is also a very plausible front-line explanation - where in western countries it simply is not due to similar demographics changing so drastically over a generation or two while removing the immigration confounder.
> To me, the much more plausible explanation is that there is some aspect of modern life
Yeah, it's the diet combined with a relatively fast switch to sedentary lifestyles. Mostly the diet and food environment. Participation in adult casual sporting leagues and other outdoor activities is right behind it. Changes in the average activity levels while at work. Just 12,000 steps a day makes a drastic difference in weight for many people.
Technology plays a major role - screen time went from minutes a day to double-digit hours for the majority of the population. Hard to be active while staring at a screen of any sort.
Like I said - I'm also open to some environmental variable not explained by much simpler facts like the food environment, but I think that's exceedingly less likely than what is smack dab obviously right in front of our faces that for some reason we ignore in pursuit of near-conspiracy level stuff. The obvious thing usually ends up being true, and I see no reason in this case to believe otherwise.
Again though - exceptions abound. Humans are complex creatures. They average out quite well though at population scale.
I'm T2D - I've come to believe obesity is a side effect of diabetes, if I'm not on my medications, I can fast for 2-3 days before my blood sugar comes down, because my liver is constantly pumping out glucose into my system.
There is no doubt that hyper processed foods make this condition more likely, but its not just "you have weak willpower and got fat and sick" - I know a ton of fat people who do not have and will likely will never develop T2D.
There is no doubt that hyper processed foods make this condition more likely, but its not just "you have weak willpower and got fat and sick" - I know a ton of fat people who do not have and will likely will never develop T2D.
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I think obesity just speeds up the onset, plenty of older skinny people with heart disease.
This is just my unqualified opinion to be clear
This is just my unqualified opinion to be clear
I can run 10 km, MTB 30 km, fat level at 18% and still have prediabetes.
Sometimes is just a bad roll on the genes.
Sometimes is just a bad roll on the genes.
I know that by modern standards, 18% is better than average, but it's also still pretty fat for men. Men should strive for a 10-14% range. <10% is associated with hormone (specifically testosterone) deficiency, and >14% is both aesthetically disgusting, and bad for metabolic health.
Try losing more fat, to the 12% level, then check your biomarkers again.
Try losing more fat, to the 12% level, then check your biomarkers again.
What does metformin have to do with it?
I'm not obese, but I'm on metformin.
HbA1c, or just diabetes as a binary variable, has been one of the main inputs into predicting heart attack risk for a long time.
The main marker of kidney function, eGFR, was added with the AHA/ACC's PREVENT equations in 2023.
I wrote a bit about the science behind heart risk calculators, and their various inputs like cholesterol, blood pressure, A1c, eGFR, and so on here: https://www.empirical.health/blog/heart-attack-risk-calculat...
The main marker of kidney function, eGFR, was added with the AHA/ACC's PREVENT equations in 2023.
I wrote a bit about the science behind heart risk calculators, and their various inputs like cholesterol, blood pressure, A1c, eGFR, and so on here: https://www.empirical.health/blog/heart-attack-risk-calculat...
> Amy Bies was recovering in the hospital from injuries inflicted during a car accident in May 2007
When an article starts like this, I instantly close it and wait for proper sources. Anyway, the phrase "metabolic syndrome" has been gaining currency for the last few years. For those who don't want to read journal papers and meta-analyses, there are plenty of doctors and fitness coaches (on YouTube) who have made videos on how to get metabolic syndrome under control or even reverse it. And many of the doctors do a good job of filtering and summarizing the research.
When an article starts like this, I instantly close it and wait for proper sources. Anyway, the phrase "metabolic syndrome" has been gaining currency for the last few years. For those who don't want to read journal papers and meta-analyses, there are plenty of doctors and fitness coaches (on YouTube) who have made videos on how to get metabolic syndrome under control or even reverse it. And many of the doctors do a good job of filtering and summarizing the research.
The term Metabolic Syndrome X has been around for more than a few years, unless nearly 40 is few (and I absolutely relate to that sentiment), just saying that concept was revved up in the 90s and of course has been an academic discussion going back to the early 20th century.
https://www.ahajournals.org/doi/10.1161/01.atv.0000111245.75...
https://pubmed.ncbi.nlm.nih.gov/3056758/
https://www.ahajournals.org/doi/10.1161/01.atv.0000111245.75...
https://pubmed.ncbi.nlm.nih.gov/3056758/
Alongside all of these honest doctors and fitness coaches who espouse metabolic syndrome as the biggest health crisis of the 21st century there is a broad group of scammers and conmen who use the well backed science and literature to seed ground to push supplements and other crap.
They seem to wrap the very basic medical truth of being overweight and inactive is horrific for your health in an onion of pseudoscience bullshit, so you buy the next best product high in "antioxidants" and "polyphenols"
The actual science is unimaginably boring. Do not be overweight on the BMI scale and do some moderate exercise for around 2 hours every week. This will drastically improve the health 1000x more than say the insane stuff that Brian Johnson is touting.
I hate modern fitness influencers and health wellness people in general. My head near about exploded when I saw a Tiktok from Jeff Nippard claiming that eggs increase your testosterone on a study with a sample size of FIVE PEOPLE.
The actual science is unimaginably boring. Do not be overweight on the BMI scale and do some moderate exercise for around 2 hours every week. This will drastically improve the health 1000x more than say the insane stuff that Brian Johnson is touting.
I hate modern fitness influencers and health wellness people in general. My head near about exploded when I saw a Tiktok from Jeff Nippard claiming that eggs increase your testosterone on a study with a sample size of FIVE PEOPLE.
> The actual science is unimaginably boring. Do not be overweight on the BMI scale and do some moderate exercise for around 2 hours every week.
Don't be depressed is also excellent advice for people with depression: if they can manage that, it improves their mood tremendously. Not catching colds also greatly reduces your chances of cold-like symptoms.
By which I mean, what you're saying is a truism, not medical advice. Keeping your BMI under control is a natural no-effort thing for some people, and a grueling lifelong struggle for others. Telling fat people to stop being fat is not "advice", it is exactly as helpful as telling sick people to stop being sick.
Don't be depressed is also excellent advice for people with depression: if they can manage that, it improves their mood tremendously. Not catching colds also greatly reduces your chances of cold-like symptoms.
By which I mean, what you're saying is a truism, not medical advice. Keeping your BMI under control is a natural no-effort thing for some people, and a grueling lifelong struggle for others. Telling fat people to stop being fat is not "advice", it is exactly as helpful as telling sick people to stop being sick.
Absolutely, the issue of obesity is not just getting people to exercise more I 100% agree. The actual science of having someone diet, exercise and stick to that engagement is literally endlessly complicated and part of the reason why GLP-1 drugs are a big deal they can be given to almost anyone who meet the clinical criteria and see a drastic improvement in overall health and mortality.
That doesn't detach from the reality of the objectives, getting there is difficult for people and there is more research to be done.
FYI: None of my posts are medical advice and I am not a doctor
That doesn't detach from the reality of the objectives, getting there is difficult for people and there is more research to be done.
FYI: None of my posts are medical advice and I am not a doctor
> When an article starts like this, I instantly close it
Why? You don't believe in car crashes or what?
Why? You don't believe in car crashes or what?
I think they probably mean “article that’s meant to share research but mostly shares anecdotes”. It’s a common framing for this kind of thing though, so they probably have to close a lot of articles after the first sentence.
A friend of mine told me a few days ago that he thinks LLMs are already smarter than most humans. I agreed with him instantly.
Someone who wants to tell you something true doesn't lead their communication with emotional distraction. Kinda like how someone who is asking a real question doesn't disguise the question as an insult.
>Someone who wants to tell you something true doesn't lead their communication with emotional distraction.
This seems needlessly cynical. Someone can have multiple objectives in writing, to tell you facts and also to capture your attention or to convey an emotion and motivate you to action. Very little writing is done with a single purpose in mind. We don’t expect academics drafting research papers to eschew concerns about the impact the writing will have on their career for example.
Starting a story with an anecdote that humanizes the information is simply acknowledging the reality that people want more than just facts. If the latter was all they wanted, most of us would only read encyclopedias and textbooks.
This seems needlessly cynical. Someone can have multiple objectives in writing, to tell you facts and also to capture your attention or to convey an emotion and motivate you to action. Very little writing is done with a single purpose in mind. We don’t expect academics drafting research papers to eschew concerns about the impact the writing will have on their career for example.
Starting a story with an anecdote that humanizes the information is simply acknowledging the reality that people want more than just facts. If the latter was all they wanted, most of us would only read encyclopedias and textbooks.
In this case it really was just pointless distracting filler. The article would have been better without it. I reach for different books when I want drama or entertainment than when I want data and research. This article promises one thing and then clumsily shoves something else in randomly throughout. It really is obnoxious.
It's not emotional distraction, it establishes the reason the subject was getting blood tests, which is revealed later in the same sentence. If this is your level of reading stamina you must find yourself very poorly informed. Even a tweet would be too long for you.
it's just fucking annoying, really. just a really irritating, baity way to write
tldr
You will not build reading stamina or make yourself well informed with sappy stories. Learn some basic statistics and try reading research papers directly. "I have read more words" is a measure of only that, and nothing else. Maybe also a measure of the ability to not be able to separate wheat from chaff.
It's extremely lazy "writing".
Seems absolutely unnecessary, forced, immeasurably trite, off-puttingly boring, overused, so brazenly cliché that there has to be some kind of counter-intuitive selection going on, like with the email scammers that target those who are not immediately noticing the fraudulent intent.
... or simply our arrogance is showing, after all average minds discuss people, right?
Seems absolutely unnecessary, forced, immeasurably trite, off-puttingly boring, overused, so brazenly cliché that there has to be some kind of counter-intuitive selection going on, like with the email scammers that target those who are not immediately noticing the fraudulent intent.
... or simply our arrogance is showing, after all average minds discuss people, right?
How many major national magazines have published your superior articles?
How many major national magazines publish good articles? The inverted pyramid is from newspapers and bears resemblance to scientific publishing while magazines bear more resemblance to the human interest crap between events when presenting the Olympics. Perfectly fine I suppose but then it's nice if they don't get confused about appropriate subjects.
It is all interconnected, but I am unsure about the claim made. The reason is simple: there can be numerous disease types. Person A may have different genetics than Person B, as one example, so responses of a body may be different for that reason alone; then there is lifestyle choice, health, age and so forth. So I don't agree with the claim in the title here that all is one ailment - that makes no sense to me.
We are reasonably confident that diabetes causes heart and kidney disease. However the converse - if I have heart disease (or kidney) I also have diabetes is not true: there are many possible causes of heart or kidney disease.
This logic error is easy to make, and the headlines all too often imply it, but it isn't always true (sometimes it is).
This logic error is easy to make, and the headlines all too often imply it, but it isn't always true (sometimes it is).
I generally agree. It's all interconnected, and we could point to a singular cause, but to treat them all as one and of the same class of disease seems reductive and not useful.
Though, to be play devil's advocate for a second, it does seem that diabetes is typically where the symptoms start, and we do understand that diabetes is fundamentally metabolic and/or functional dysfunction in 1 or more of 7-ish different areas.
I think it's the level of perspective zoom + timing we take that makes the article's assertion either useful or not.
If we zoom out, while catching disease early on, and we address the metabolic conditions via lifestyle and/or certain drugs like GLP1, then we prevent the need to intervene on the kidney and cardiac front.
But if we zoom in to a specific issue, after disease has progressed a profound amount, a GLP1 intervention may be too little, too late.
Hopefully though, this may help the messaging to folks that if they are contending with metabolic disease that presents as diabetes, introducing lifestyle and pharma interventions early may be helpful on the larger epidemiological front.
Though, to be play devil's advocate for a second, it does seem that diabetes is typically where the symptoms start, and we do understand that diabetes is fundamentally metabolic and/or functional dysfunction in 1 or more of 7-ish different areas.
I think it's the level of perspective zoom + timing we take that makes the article's assertion either useful or not.
If we zoom out, while catching disease early on, and we address the metabolic conditions via lifestyle and/or certain drugs like GLP1, then we prevent the need to intervene on the kidney and cardiac front.
But if we zoom in to a specific issue, after disease has progressed a profound amount, a GLP1 intervention may be too little, too late.
Hopefully though, this may help the messaging to folks that if they are contending with metabolic disease that presents as diabetes, introducing lifestyle and pharma interventions early may be helpful on the larger epidemiological front.
> The ties are so strong that in 2023 the American Heart Association grouped the conditions under one name: cardio-kidney-metabolic syndrome (CKM), with “metabolic syndrome” referring to diabetes and obesity.
Seems like this is mostly an extension of the previously existing label of metabolic syndrome, now including kidney. Ozempic is mentioned and I take that to mean obesity is the cause. But are some of these ailments like diabetes reversible?
Seems like this is mostly an extension of the previously existing label of metabolic syndrome, now including kidney. Ozempic is mentioned and I take that to mean obesity is the cause. But are some of these ailments like diabetes reversible?
I think it's saying that diabetes (T2 is reliably reversible) causes damage to the heart and kidney but sometimes the connection isn't made and they treat the kidney/heart symptoms without addressing the cause (T2D).
Interesting I didn’t realize T2 is reversible. How do people do that - some kind of drug? Or just weight loss?
Here's a protocol from a small study where 90+% reversed their T2D. https://link.springer.com/article/10.1186/s12916-025-04072-4
tl;dr it's everything you expect - home-cooked healthy meals, avoid sugary stuff, moderate exercise five days per week, etc
tl;dr it's everything you expect - home-cooked healthy meals, avoid sugary stuff, moderate exercise five days per week, etc
You skipped over the part where they were also still taking the standard hypoglycemic agents - in other words, medications to manage blood glucose. The study also tracked people who were both obese and newly diagnosed as diabetic. It says so in the conclusion.
Also, remember not everyone with T2 is obese, not everyone obese has T2D, and obesity doesn’t mean a little overweight. These are people with a BMI of 30 or higher. Other, lesser-used definitions from the past included a certain percentage of body weight consisting of fat. There are many people with Type 2 who are normal weight or overweight.
Also, remember not everyone with T2 is obese, not everyone obese has T2D, and obesity doesn’t mean a little overweight. These are people with a BMI of 30 or higher. Other, lesser-used definitions from the past included a certain percentage of body weight consisting of fat. There are many people with Type 2 who are normal weight or overweight.
Yes, and? What point are you trying to make?
> T2D remission is defined as glycated hemoglobin (HbA1c) < 6.5% after discontinuation of hypoglycemic drugs for at least 3 months
> In the intensive treatment group, 78.57% patients in the prediabetes subgroup returned to normoglycemia and the diabetes remission rate was 75% in the diabetes subgroup at 12 months
75% of T2D people in this study were able to get cured and stop medications. It's a good outcome.
> T2D remission is defined as glycated hemoglobin (HbA1c) < 6.5% after discontinuation of hypoglycemic drugs for at least 3 months
> In the intensive treatment group, 78.57% patients in the prediabetes subgroup returned to normoglycemia and the diabetes remission rate was 75% in the diabetes subgroup at 12 months
75% of T2D people in this study were able to get cured and stop medications. It's a good outcome.
> in this study
Okay here's another one using intermittent fasting where half were able to eliminate or reduce medication sustained a year after the intervention: https://academic.oup.com/jcem/article/108/6/1415/6888005?log...
That’s a more meaningful study than the first one for T2D in general, because it’s full diabetes diagnosis and between 1 and 11 years with it. That’s much different from prediabetes and fresh diagnoses.
The mean BMI in the study is around 24, which is overweight rather than obese. Their blood pressure was close to normal. Their A1C was in the diabetic range before intervention, but well below 8 so it was somewhat controlled.
After 12 months, 44% of people in the intervention group were off all their blood glucose meds. That’s far, far better than the control group for sure. It’s still not everyone in the intervention group.
This is also a pretty specific method of intermittent fasting, not just self control on a traditional meal schedule. So no, I don’t think this 72-person study shows that just having some self control solves T2D for everyone either. It looks like enough self control to stick to a specific, predesigned eating schedule works for almost half of people, though. That’s really good, but let’s not oversell it as a 100% cure.
The mean BMI in the study is around 24, which is overweight rather than obese. Their blood pressure was close to normal. Their A1C was in the diabetic range before intervention, but well below 8 so it was somewhat controlled.
After 12 months, 44% of people in the intervention group were off all their blood glucose meds. That’s far, far better than the control group for sure. It’s still not everyone in the intervention group.
This is also a pretty specific method of intermittent fasting, not just self control on a traditional meal schedule. So no, I don’t think this 72-person study shows that just having some self control solves T2D for everyone either. It looks like enough self control to stick to a specific, predesigned eating schedule works for almost half of people, though. That’s really good, but let’s not oversell it as a 100% cure.
If about half or more of people can reliably reverse T2D with lifestyle then I think my original statement stands. There are a bunch of these studies with slightly different flavors.
There are 90 year olds with 60 years of diabetes and no complications and 40 year olds with 3 years of diabetes and devastating complications. Same for heart and kidney disease. They cannot be put in the same basket. No matter how much they try to push GLP-1's for everything under the sun, they are not.
If they find the drug of immortality, I am sure they will name every disease "partial death".
If they find the drug of immortality, I am sure they will name every disease "partial death".
The article is trying so hard not to say that obesity is the cause. I call it the obesity pipeline: You start off young and obese and you don't have diabetes and it's all fine. Stay obese long enough and you get diabetes -> metformin. Stay in a diabetic state long enough and you get heart disease -> statins. These are obesity comorbidities.