A sad story about diabetic kidney disease

November 2014

During the last 3-4 decades we have seen a type-2 diabetes epidemic in almost all countries. It started a few years after the introduction of the dietary guidelines in the late seventies according to which we should exchange dietary fat with food rich in carbohydrates. These recommendations were directed to diabetics as well, although no one had tested this diet on diabetic patients and although the usual dietary advice to diabetics was to avoid sugary food and other carbohydrates.

Before the discovery of insulin all patients with type 1 diabetes, the type that usually starts in childhood, died shortly after the diagnosis was settled. However, Karl Petrén a Swedish professor in medicine succeeded in keeping patients with type-1 diabetes alive for several years with an extreme low-carbohydrate diet. Today patients with type 2 diabetes, the type that starts later in life, are able to survive without insulin if they adhere to a lowcarb diet.

If diabetics eat a highcarb diet instead, as suggested by the NHLBI and AHA, they become fat, they have to inject insulin every day and sooner or later they may suffer from the many sequels of type 2 diabetes. One of them is kidney failure. Today about half of the patients on the dialysis departments suffer from diabetic kidney disease.

There is no doubt that the diabetes epidemic is caused by too many carbohydrates in our diet. The strongest proof is that more than 20 dietary trials including only type 2 diabetics or patients with decreased insulin sensitivity have shown that a lowcarb/highfat (LCHF) diet is able to improve and even normalize all the laboratory signs of diabetes, and many of the participants have been able to quit their insulin and other antidiabetic drugs. You can read more about that in this review by Richard Feinman and his coworkers

One of my colleagues, Jørgen Vesti Nielsen, has even been able to reverse a diabetic patient´s progressive kidney disease. This is a most revolutionary finding. During my 11 years on the Department of Nephrology, University of Lund I have never seen a patient who recovered from a diabetic kidney disease; sooner or later they died or they ended up on the dialysis department.

There may be another way to heal a diabetic kidney disease. At the Department of Nephrology I was the head of a research team studying glomerulonephritis, the commonest kidney disease at that time. We and several other research team around the world found that most patients with renal failure due to glomerulonephritis had been exposed to various types of organic solvents and fuels, and we also succeeded in reversing the course by asking the patients to stop the exposure. Many other chemicals are toxic to the kidneys as well. The common denominator is that they are tubulotoxic, meaning that they harm the tubules of the kidney. You can read more about this issue here.

Later on, Magdi Yaqoop. a British nephrologist and his team studied this issue in patients with type 2 diabetes and kidney disease and found that such exposure was common among such patients as well. It is therefore not farfetched to assume that elimination of all kinds of toxic exposure may reverse diabetic kidney disease as well. Now to the sad story.

A few weeks ago KatherineTuttle and her 13 coworkers from various universities and institutions in the US published a review about diabetic kidney disease in the journal Diabetes Care in collaboration with the American Society of Nephrology and the National Kidney Foundation. Finally, I thought, the truth may appear. But I was wrong. Their paper had 190 references to the medical literature, but not a word about the LCHF diet or the effect of being exposed to tubulotoxic chemicals. Therefore I sent a letter to the journal:

In the report from the ADA consensus conference about diabetic kidney disease Tuttle et al. warn against a high-fat diet because it may exacerbate hyperlipidemia and therefore can be inferred to increase CVD risk (1). However, apart from a significant decrease of the triglycerides several lowcarb/highfat (LCHF) trials on type 2 diabetics and/or prediabetics have shown only insignificant effects on the blood lipids (2).

In a case report Nielsen et al. have shown that in addition to a significant reduction in bodyweight and improved glycaemic control, the LCHF diet was able to stop and reverse a six year long decline of renal function (4).

It was not mentioned either in the ADA report that compared with diabetics with normal kidneys, diabetics with chronic renal failure have or have had a significantly higher level of exposure to tubulotoxic chemicals, such as lead, chromium, tin, mercury welding fumes, silicon-containing compounds and hydrocarbons (5).

Therefore, in the management of diabetic kidney disease there are good reasons to suggest the patients to try an LCHF-diet. It may also be beneficial to investigate possible exposure to tubulotoxic chemicals, preferably in cooperation with occupational hygienists, because several authors have reported that cessation of such exposure may stop the progress of other types of kidney diseases and even improve renal function (5).

References

  1. Tuttle KR, Bakris GL, Bilous RW et al. Diabetic kidney disease: A report from an ADA consensus conference. Diabetes Care 2014;37:2864–2883.
  2. Feinman RD, Pogozelski WK, Astrup A et al. Dietary Carbohydrate restriction as the first approach in diabetes management. Critical review and evidence base. Nutrition 2014, In press. DOI: 10.1016/j.nut.2014.06.011
  3. Nielsen JV, Westerlund P, Bygren P. A low-carbohydrate diet may prevent end-stage renal failure in type 2 diabetes. A case report. Nutr Metab (Lond). 2006;3:23.
  4. Ravnskov U. The crucial role of tubulotoxic chemicals in renal failure. OA Nephrology 2013;1:14-18.

A few days later i received the following letter from the editors (Italics by me):

Dear Dr. Ravnskov:

Your manuscript, as titled above, has been carefully evaluated by the Editor and the Editorial Committee. Due to the large number of letters submitted to Diabetes Care, the journal has had to put in a system to assess priority. All papers and letters must meet a priority score in the upper 50th percentile to be considered for publication. There are many aspects in an evaluation. A paper or letter is scored for its hypothesis testing, suitable controls, appropriate statistical methods, results, conclusions supported by the results, and clear interpretation.

A paper or letter is also selected on its uniqueness, novel or new approach, current importance, and readership interest. Though data collected might be eventually important, the editors may not feel that a paper currently contains sufficient novel information to assign a high priority score.

After careful consideration, we were unable to assign your letter sufficient priority for publication in Diabetes Care.

Diabetes Care continues to receive more quality manuscripts than it is possible to publish. (Current submissions average 250 per month.)

We believe it is our responsibility to authors such as yourself to inform you of a negative decision as soon as possible in order to facilitate your ability to rapidly submit your work elsewhere for consideration. Please note, it is recommended that any further discussion related to the manuscript and/or decision be done via email or any other written format.

The Editorial Team of Diabetes Care greatly appreciates the opportunity to evaluate your contribution and wishes you good fortune in the future publication of your work.

Sincerely,

William T. Cefalu, MD, Editor
American Diabetes Association Editorial Office
5110 Commerce Square Dr., Suite G
Indianapolis, IN 46237

I noticed that most of the authors of the paper were supported financially by several drug companies. As my suggested ”treatment”, if successful, obviously would result in a substantial decrease of all types of antidiabetic drugs, I thought that it might be better to send my letter to a journal about kidney disease and accordingly I sent it to Kidney International.Two days later I received the following email:

Dear Dr. Ravnskov:

I am writing to you on behalf of Kidney International’s Editorial Board to thank you for submitting your manuscript, entitled ”Diabetic kidney disease may be reversible” (KI-10-14-1505).

The Board has now had a chance to carefully consider your manuscript, but I regret to inform you that we feel the manuscript would not be appropriate for publication in the journal.

Almost 1500 manuscripts are submitted annually to KI, of which only a small percentage can be published. To facilitate the review process, we submit all manuscripts to a review by the Editor in Chief and an Associate Editor who is an expert in your field to determine whether the paper is likely to withstand the rigorous review process of KI. A quick decision like this will save you time allowing you to immediately submit the paper to another journal. A further consideration is the general appeal of the paper to the wide-ranging readership of KI. We want to stress that this decision was entirely based on issues relating to the priority assigned to your work relative to the other submissions under consideration.

Thank you for allowing us to review this work. We hope that you will continue to consider sending your work to KI in the future.

Sincerely,

Pat Morrissey
Executive Managing Editor
For the Editors

Hm, perhaps another kidney journal would be appropriate and I sent my letter to American Journal of Kidney Diseases. A few days later I got the following email:

Dear Dr. Ravnskov,We received your item entitled ”Diabetic kidney disease may be reversible” for the Correspondence section of AJKD, and regret to inform you that we will not be able to publish it in the journal.

We are unable to publish all the letters we receive. However, we will be glad to forward your letter directly to the authors of the article to which you refer. We plan to take this step in 2 days, so if you have any objection to the letter being forwarded, please contact us within that timeframe.

Thank you for your interest in the journal.

Sincerely,

Andrew S. Levey, MD, FNKF Daniel E. Weiner, MD, MS, FNKF
-in-Chief Deputy Editor

 

Why can´t even editors of kidney journals accept my letters? Is the reason that many kidney experts earn much money for every patient they treat at their dialysis department? Or am i paranoid?

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