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In recent years, a growing body of evidence has emerged on the benefits of plant-based diets for the prevention and treatment of lifestyle diseases. In parallel, data now exist regarding the treatment of chronic kidney disease and its most common complications with this dietary pattern. Improving the nutrient quality of foods consumed by patients by including a higher proportion of plant-based foods while reducing total and animal protein intake may reduce the need for or complement nephroprotective medications, improve kidney disease complications, and perhaps favorably affect disease progression and patient survival. In this In Practice article, we review the available evidence on plant-dominant fiber-rich diet as it relates to kidney disease prevention, chronic kidney disease incidence and progression, metabolic acidosis, hyperphosphatemia, hypertension, uremic toxins, need for kidney replacement therapy including dialysis, patient satisfaction and quality of life, and mortality. Further, concerns of hyperkalemia and protein inadequacy, which are often associated with plant-based diets, are also reviewed in the context of available evidence. It is likely that the risks for both issues may not have been as significant as previously thought, while the advantages are vast. In conclusion, the risk to benefit ratio of plant-based diets appears to be tilting in favor of their more prevalent use.

Objective To determine whether participation in a lifestyle medicine intervention is associated with improved nutrition behaviors. Use of Theory or Research Past research has demonstrated the effectiveness of plant-based diets in improving health. Target Audience Adults in New York City (NYC) with type 2 diabetes, prediabetes, high blood pressure, high cholesterol, excess weight, and/or heart disease. Program Description The Plant-Based Lifestyle Medicine (PBLM) Program is a pilot program designed to help individuals reduce their cardiometabolic risk through lifestyle changes. Providers with expertise in plant-based nutrition (physicians, registered dietician, health coach) educate and support patients in adopting a whole-foods plant-based diet and other healthful lifestyle changes. Patients meet individually with each provider to set goals and monitor progress. Group visits supplement one-on-one visits, include education and skills building, and foster peer-to-peer support. Evaluation Methods All PBLM participants were invited to participate in the evaluation; 131 agreed to be contacted; 85% provided consent. Data came from surveys of participants at baseline, 3-months, and 6-months (83%, 85%, 80% response rates respectively). Surveys measured nutrition knowledge, dietary intake, self-rated health, barriers to adopting a plant-based diet, and motivation and confidence in adhering to a plant-based diet. Results Participants were on average 53 years old, mostly female, roughly two-thirds were Black or White, and the majority completed college or more. Participants demonstrated statistically significant short-term improvements and maintained longer-term improvements in all domains of interest including nutrition knowledge; barriers to adopting a plant-based diet; motivation and confidence in plant-based diet adherence; increased consumption of non-animal protein and fruits/vegetables; decreased consumption of animal protein, sweets, and oil; and self-rated health. Consumption of whole grains was the only food category to not show improvements longer-term. Conclusions PBLM shows promise in improving participants’ nutrition behaviors within a healthcare setting. Additional studies are needed to demonstrate the effectiveness of changing nutrition behaviors and achieving positive clinical outcomes through participation in a lifestyle medicine intervention. Funding NYC Health and Hospitals Corporation.

Hallberg et al. provide a limited literature review on the reversal of type 2 diabetes mellitus (T2DM) [...]

Patients with type 2 diabetes mellitus (T2DM) and a body mass index (BMI) >35 kg/m are currently eligible for bariatric surgery, according to the 1991 NIH Consensus Criteria for bariatric surgery. Up to 78% of patients with T2DM experience diabetes remission within 2 years after bariatric surgery. Evidence exists that changes in the gut hormonal milieu after gastric bypass can improve insulin resistance immediately after surgery and preceding substantial weight loss. In 2007, the American Society of Bariatric Surgery added “Metabolic Surgery” to its name. Patients with T2DM and BMI

Up to 78% of patients with type 2 diabetes mellitus (T2DM) may experience diabetes remission within two years after bariatric surgery.1 Currently, only patients with T2DM and body mass index (BMI) above 35 kg/m2 are eligible for bariatric surgery. This is based on the 1991 National Institutes of Health (NIH) Guidelines and has been endorsed by the Center for Medicare and Medicaid Services.2 Patients with T2DM and BMI < 35 are primarily offered intensive medical weight management (MWM), including pharmacotherapy and nonsurgical weight loss strategies. Millions of patients with T2DM have BMI < 35—yet metabolic surgery is not an option for them.3 There is emerging evidence supporting the use of bariatric surgery to treat diabetes in less obese (BMI < 35) patients. However, there are very few randomized trials. The Agency for Healthcare Research and Quality (AHRQ) recently identified this area as a research priority for comparative effectiveness research.4 The NIH is unlikely to change the bariatric surgery guidelines for patients with T2DM without additional evidence to support such a change.5 There is also an overall lack of treatment data in underrepresented minorities (especially Hispanics and non-Hispanic African-Americans) with T2DM, who are disproportionately affected by diabetes-related complications and mortality. Our municipal health care system serves a substantial number of these “hard-to-reach” minorities. The receptor for advanced glycation end-products (RAGE) binds multiple ligand families linked to hyperglycemia. Activation of RAGE plays a major role in the pathogenesis of diabetic vascular complications via activation of the nuclear factor κ β pathway.6 Recent data indicate that mice devoid of RAGE who are fed high fat diet are protected from diet-induced obesity and that the treatment of diabetic mice with a soluble form of RAGE (sRAGE) results in significantly reduced body weight gain vs. vehicle-treated animals.7 Interestingly, sRAGE already circulate in human plasma. sRAGE acts as a decoy to prevent an interaction between advanced glycation end-products and RAGE and subsequent RAGE ligand-mediated effects on obesity and diabetes complications.8 Therefore, levels of sRAGE may be innate biomarkers of vulnerability to obesity and diabetes and/or their severity.9 The purpose of this study was two-fold: 1) to conduct a pilot randomized trial to compare bariatric surgery to MWM in patients with T2DM and BMI 30–35 who otherwise met NIH criteria for surgery, and 2) to assess the role of sRAGE as a biomarker for predictor of success after surgery. Due to the fact that insurance companies typically cover bariatric surgery in patients with T2DM and BMI > 35, we partnered with our municipal healthcare system’s primary insurer, who agreed to cover the costs of the surgery as part of this research project.

Genitourinary tuberculosis (TB) is infrequently reported in the United States, but is a common form of extrapulmonary TB that often goes unnoticed due to its insidious and sometimes asymptomatic presentation. Prostate involvement and the development of tuberculous prostatic abscesses have been reported in the literature largely in association with human immunodeficiency virus (HIV) infection and acquired immunodeficiency syndrome (AIDS). We report a case of disseminated TB involving tuberculous prostatic abscesses in a patient without HIV/AIDS, presenting with sepsis and urinary symptoms. This patient had simultaneous prostatic, peritoneal, pulmonary, and likely renal TB, serving as a reminder to clinicians that multi-organ presentations of TB do occur in patients without overt immunosuppressive conditions. This case also highlights the importance of considering the diagnosis of genitourinary TB in patients with risk factors for TB presenting with vague, long-standing urinary symptoms.