6 ms·

Heart and Kidney Diseases and Type 2 Diabetes May Be One Ailment

73 points by Brajeshwar 11mo ago

SilverElfin 11mo ago
> 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?
- liveoneggs 11mo ago
  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).
  - SilverElfin 11mo ago
    Interesting I didn’t realize T2 is reversible. How do people do that - some kind of drug? Or just weight loss?
    - liveoneggs 11mo ago
      Here's a protocol from a small study where 90+% reversed their T2D. https://link.springer.com/article/10.1186/s12916-025-04072-4 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
      - cestith 11mo ago
        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.
        liveoneggs 11mo ago
        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.
        cestith 11mo ago
        > in this study
        liveoneggs 11mo ago
        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?login=false#405932118 https://academic.oup.com/jcem/article/108/6/1415/6888005?log...
        cestith 11mo ago
        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.
qart 11mo ago
> 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.
- jeffbee 11mo ago
  > When an article starts like this, I instantly close it Why? You don't believe in car crashes or what?
  - gnatman 11mo ago
    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.
    - qart 11mo ago
      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.
  - nh23423fefe 11mo ago
    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.
    - jeffbee 11mo ago
      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.
shevy-java 11mo ago
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.
- bluGill 11mo ago
  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).
- itchyouch 11mo ago
  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.
brandonb 11mo ago
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-calculator/ https://www.empirical.health/blog/heart-attack-risk-calculat...
matthewaveryusa 11mo ago
>These three disorders could really be “CKM syndrome,” which can be treated with drugs like Ozempic 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.
- deleted 11mo ago
  [deleted]
- tsimionescu 11mo ago
  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.
  - phil21 11mo ago
    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.
tsoukase 11mo ago
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".

73 points by Brajeshwar 11mo ago

> 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?

liveoneggs 11mo ago
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).
- SilverElfin 11mo ago
  Interesting I didn’t realize T2 is reversible. How do people do that - some kind of drug? Or just weight loss?
  - liveoneggs 11mo ago
    Here's a protocol from a small study where 90+% reversed their T2D. https://link.springer.com/article/10.1186/s12916-025-04072-4 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
    - cestith 11mo ago
      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.
      - liveoneggs 11mo ago
        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.
        cestith 11mo ago
        > in this study
        liveoneggs 11mo ago
        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?login=false#405932118 https://academic.oup.com/jcem/article/108/6/1415/6888005?log...
        cestith 11mo ago
        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.

qart 11mo ago

> 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.

jeffbee 11mo ago
> When an article starts like this, I instantly close it Why? You don't believe in car crashes or what?
- gnatman 11mo ago
  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.
  - qart 11mo ago
    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.
- nh23423fefe 11mo ago
  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.
  - jeffbee 11mo ago
    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.

shevy-java 11mo ago

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.

bluGill 11mo ago
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).
itchyouch 11mo ago
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.

brandonb 11mo ago

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-calculator/ https://www.empirical.health/blog/heart-attack-risk-calculat...

matthewaveryusa 11mo ago

>These three disorders could really be “CKM syndrome,” which can be treated with drugs like Ozempic 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.

deleted 11mo ago
[deleted]
tsimionescu 11mo ago
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.
- phil21 11mo ago
  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.

tsoukase 11mo ago

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".