The Get Healthy Tampa Bay Podcast

E153: Dr. Raeeda Gheewala on Sports Nephrology—Hydration, NSAIDs, Protein & Kidneys

• Kerry Reller

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Welcome to the Get Healthy Tampa Bay Podcast with Dr. Kerry Reller! This week, I am joined by Dr. Raeeda Gheewala—“the Kidney Queen”—a double board-certified internist and nephrologist pioneering the field of sports nephrology, where kidney health meets athletic performance. In this episode, we explore how hydration, heat illness, pain medications like NSAIDs, high-protein diets, creatine, caffeine, and electrolyte drinks can impact kidney function. Dr. Gheewala shares warning signs athletes shouldn’t ignore (like blood in the urine and foamy urine), practical hydration strategies, how to avoid heat-related kidney injury, and when primary care should screen and refer for silent kidney disease. Tune in to learn how to protect your kidneys while supporting peak performance and long-term health.

Dr. Raeeda Gheewala is a double board-certified physician in Internal Medicine and Nephrology with over two decades of clinical experience. She has dedicated her career to advancing kidney health and exploring its vital connection to physical performance. As one of the few specialists in Sports Nephrology, Dr. Gheewala blends her expertise in kidney medicine with her passion for sports and wellness—helping athletes optimize hydration, recovery, and kidney function for peak performance.

Beyond her clinical work, she advocates for prevention and proactive health, empowering individuals to protect their kidneys through informed lifestyle choices. Her patient-centered, holistic approach has earned her respect among colleagues and athletes alike.

Dr. Gheewala continues to educate and inspire through her practice, speaking engagements, and online platform, where she shares evidence-based insights on how balanced living supports kidney and overall health.

00:28 – Intro to Dr. Raeeda Gheewala + “sports nephrology”
01:12 – The former NFL player story that sparked her mission
04:29 – Why kidney health is overlooked + what labs matter (GFR)
07:27 – Heat illness spectrum: heat exhaustion → heat stroke
09:42 – Dehydration + low blood flow: how kidneys get injured
11:31 – NSAIDs after workouts: the “worst time” to take ibuprofen
13:39 – High-protein intake: performance needs vs kidney strain
16:03 – Creatine: what’s safe, what’s misunderstood, what to monitor
21:00 – Overhydration + hyponatremia: why electrolytes matter
36:33 – When to screen/ refer: silent kidney disease + ACR + kidney function

Connect with Dr. Gheewala
Website: sportsnephrology.com
Instagram: @thekidneyqueenmd
YouTube: TheKidneyQueenMD
TikTok: @sportskidneycoach

Connect with Dr. Reller
Podcast website: https://gethealthytbpodcast.buzzsprou... 
LinkedIn: https://www.linkedin.com/in/kerryrellermd/
Facebook: https://www.facebook.com/ClearwaterFamilyMedicine
Instagram: https://www.instagram.com/clearwaterfamilymedicine/
Tiktok: https://www.tiktok.com/@kerryrellermd
Clearwater Family Medicine and Allergy website: https://sites.google.com/view/clearwa...
Podcast: https://gethealthytbpodcast.buzzsprou...

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Kerry:

Hi everybody. Welcome back to the Get Healthy Tampa Bay podcast. I'm your host, Dr. Kerry Reller, and today we have Dr. Raeeda Gheewala. Welcome to the podcast.

Raeeda:

Good to be here.

Kerry:

we're very excited to have you. So Dr. Gheewala is the kidney queen, a double board certified internist and nephrologist with over two decades of experience, she's pioneering the field of sports nephrology where kidney health meets athletic performance. So we're gonna explore hydration, pain management, high protein diets, heat illness, and whatever every athlete needs to know about protecting their kidneys in the amount of time that we have today. So, Dr. Gheewala, why don't you tell us a little bit about who you are and what you do.

Raeeda:

Thank you. Thank you for having me. So yeah, I'm Dr. Gheewala. I am, as you mentioned, an internist and nephrologist practicing in Austin, Texas been practicing for almost two decades. And I started seeing patients who are athletes with kidney problems and not only kidney problems, but also but advanced kidney disease to the point where, you know, my the patient who really made me think about sports was a 30 5-year-old former NFL player, and by the time he came and saw me, he already had kidney disease, not only kidney failure. And our first conversation was really about needing to start dialysis, having the conversation to start dialysis. And he was you know, a college football player and then a NFL player. And I was shocked. I said, why? Why did you not have the best medical care? Why didn't you have access to a kidney doctor early on? And and he told me story after story that again, really took me aback about how he was fed steaks to bulk up that made his gout flares up so many times. Then he had blood pressure problems throughout for a whole decade. And that his physicals every year, I said, I asked him, why didn't you have a physical every year? How didn't, why wasn't your blood pressure controlled? And he said sometimes there was no blood pressure cuff at the physical and that he was just signed off to keep playing. And it just really, you know, broke my heart. And I was like, this needs, I, I need to do something about this. I need to take some action. And, that's why I, I pioneered sports nephrology. I said I'm the only nephrologist looking at athlete health. And and that, that's where I am now. And this, this gentleman, unfortunately, he passed away within two years of being on dialysis. 37, you know, at the top of his game. So, advanced disease that I knew that with education, awareness, prevention, preventative strategies we could have halted the disease, certainly you know, for, try not to get, you know, progressed. But he just didn't have people on his team thinking about his kidneys.

Kerry:

That's a really shocking story. I mean, you think in the NFL they would've access to like the best, you know, medical care, you know, possible and really be looking out for these things. And obviously like clearance to play, like if someone, someone's blood pressure, you know, we don't clear them if they're having elevated blood pressure. So that's it's just very shocking

Raeeda:

It

Kerry:

see that. You know, would be a great driver to kind of get involved in this, to spread awareness and everything like that. So I mean, I think there was a lot of things that you brought up. Like, I don't know if listeners know what dialysis is and like what things that hurt the kidneys that maybe could have led to his you know, issues, but maybe we'll uncover that, you know, kind of throughout our discussion today. So I mean, clearly what an inspiring. You know, mission that you have here to help athletes kind of train kidney. Smart, smart. Why do you think kidney health is overlooked as part of performance and recovery?

Raeeda:

Yeah, that's a good question. It's you know, yeah, kidneys are usually an afterthought. It's the kidney. Nobody talk thinks about the kidney until there's already kidney damage. There hasn't been really a proactive approach. It's, I I believe it really starts with, with awareness. People just don't know. It's not that they are intentionally you know, dropping the ball or not getting the care I think it's really just even the medical community there there's not a big push on prevention. There's a lot of reaction, there's a lot of reactive medicine. And, and even as with before I had athlete patients, my regular kidney patients. Were, you know, late refer referrals, meaning where I didn't have that much I could do to offer a reversal of disease or even some, you know, good treatments because the disease had all already progressed. And so I think, and bringing awareness, empowering patients, families, athletes you know, parents to question and really be curious about their blood work. Let's say we get a blood test back, you know, asking their doctor, what does this mean? And I'm gonna I wanna specifically mention GFR, which is GLO filtration rate. It's a function, it's a blood test that shows what the kidney does and how well the kidney filters the blood. The kidney's job is to clean the blood, keep the nutrients, and get rid of the wastes. And so that number very slowly goes down with age, but goes down with medical problems like high blood pressure, diabetes, recurrent dehydration heat exhaustion. So multiple reasons, multiple insults over time is usually what happens to kidneys. So I, I think a lot of it is really just awareness, education. People just don't know.

Kerry:

mm-hmm. Yeah, I can think of, you know, one of my favorite cases, I guess, as a primary care provider of doing someone's labs and checking that for their creatinine and GFR and, what I discovered was, you know, a low, obviously a lower GFR than it should be, and the patient was taking goody's headache medicine like every day, like in forever. And I definitely think that has contributed to her chronic kidney disease now. And I'm sure we're gonna get into that in a minute, but it's just, yeah, having the preventative care that's necessary to get the labs and question the labs, I think is very important to, you know, overall, you know, preventing things from happening like you're saying, which instead of reacting to problems that occur you know, later on. So very, very important to get the awareness and get the right doctor or provider to help you out to, you know, be on your team with that, no pun intended. So what should athletes and coaches know about, you know, hydration, heat, and illness and kidney function?

Raeeda:

I think, being aware, again, a lot of it is this awareness of the signs and symptoms of heat exhaustion. If you're thinking about heat exhaustion, there's a spectrum of heat exhaustion all the way to heat stroke and heat exhaustion is what's more common with a lot of people being out in the sun having, you know, ate or drank for a while. All kinds of people, whether you're an athlete or not an active person, you know, anybody can. Succumb to heat exhaustion. The people who have not who are, you know, athletes and training who have not acclimatized to, let's say the heat and they, they play on the east coast and then they go to the south and they playing a different team, for example. Those are the people at higher risk. For more severe signs of heat exhaustion that may progress to like heat stroke. And heat stroke then becomes, is a, is a medical emergency. It's when the brain is affected heat damage to the brain from heat problems. And so my, one of my missions is really to bring heat stroke in athlete health at the same level as sudden cardiac death. And concussion. Everyone knows about concussion parents. Anybody on the street knows about concussion, they know that it's an emergency. They know that there's a brain problem and they know they need to go to the er, and they need, they know they need some monitoring. Everyone knows that. And so I want heat stroke to have that same awareness for the coaches, for the athletes, and that's what I train athletic trainers about as well. Those signs and symptoms of early signs and then early intervention before even going to the hospital.

Kerry:

I mean, I know in Florida, you know, we're obviously at high risk for that, and I'm assuming Texas as well. Maybe, I'm not sure if Austin is bad, but I, and we did, I should mention, I did have a episode a couple months ago really focusing on heat illness and I think that could be definitely something to look back on if anybody's looking for some different kind of information on this. But now we're getting you know, your perspective as a kidney doctor, which I think is super important too. So so kind of over training, dehydration, what about how does that. Like affect the kidneys under stress.

Raeeda:

So anytime there is a a kidney problem, it usually has to do with low blood flow to the kidney. So the cause of the kidney problem could be different, but the result is often the same low blood flow. And so the kidneys just kind of without blood pressure, without blood flow. There's, there's an injury and sometimes it's reversible, sometimes it's not. If there are multiple injuries, that's where the chronic part comes in. And so athletes and active people are higher risk for muscle injury if they're working out too much or trying a new exercise regimen. Or like a weekend warrior who doesn't usually train this much, they can develop a muscle injury that's called rhabdomyolysis, which is a medical term for a muscle breakdown. The muscle actually dies, muscle cells die and the muscle it goes into the bloodstream and that the toxins build up and, and cause damage to the kidney. And then people can start bleeding in their urine, have blood in their urine. That's the symptom. Anyway. I had a, had a client the other day who told me. That he had those episodes of blood in his urine many times as a Iron Man athlete didn't know what it was until I think one of his family members who happened to be in medicine said, oh, I think you might have you know, muscle problem go to the er. And so since then he, you know, he told, he could remember multiple times in his, his career as just that blood in the urine is never Something to ignore. Yeah,

Kerry:

so obviously dehydration is gonna lead to that low blood flow that can injure the kidney. And then we also have these toxins that you mentioned when there's actually, you know, muscle damage and then that can also create kidney injury as well. Is that correct?

Raeeda:

that's correct. Yes. Another thing you mentioned about the the headache medicine of your, your patient. I, I do wanna mention those types of medicines that can also cause low blood flow. They're called non-steroidal anti-inflammatory medications, the ones that are all in our medicine cabinets, ibuprofen, Motrin, Advil, Aleve, percent. All these medications are usually safe once in a while. But in the person who is dehydrated or who just worked out, who has lost a lot of fluid through sweat, who's out in the sun, and then they come home and they're sore and they take an ibuprofen, that's not the good, that's the worst time to take it because you're in a dehydrated state and then you take a medicine that causes low blood flow to the kidney. So you have two insults. And so that's a, that is a higher risk time for developing kidney problems. If you come home and you hydrate, you eat, you drink, you take a shower, you cool off, and, and then you're still sore, that would be a safer time to take ibuprofen or acetaminophen Tylenol if you're still sore. If other, you know, non-pharmacological things didn't help.

Kerry:

So even that one time use in that situation could be damaging to the kidneys rather than like repetitive. Of chronic use doing that?

Raeeda:

It can in the setting of severe dehydration.

Kerry:

Mm-hmm. Okay. So, yeah, definitely those, you know, NSAIDs that we that you were mentioning are definitely something to be watching and you know, honestly reading the labels too, because you have no idea what you're taking if you don't read the labels. And then if you don't know what it is, either Google it, you know, so you know if it's in that class. Right. Or ask your doctor or something like that. Because like I said, my patient did not have any idea what she was actually taking all of the time.

Raeeda:

Because it's over the counter, right, and it's.

Kerry:

You think it's safe, right? Yeah. So we talked about, you know, kind of the pain medicine aspect of it. What about like high protein diet and supplements? There's kind of ongoing debate about that. So can, how can athletes like balance performance, nutrition with kidney preservation?

Raeeda:

So protein is needed for muscle recovery after a workout building block. Of the body. So we all need a certain amount of protein, and it really depends on the activity level. So if you are a an maybe an active person who doesn't train that much, maybe you need 0.8 to one gram per kilogram per day of protein. But if you are, you know, training a few times a week, exercising an active person maybe you need one to 1.2 grams per kilogram, but then if you're an elite athlete, you might need more 1.4 to 1.8 grams. So when we have a higher, higher demand, we need to eat more, we need to consume more protein to maintain the certain muscle mass but it's when the protein intake exceeds two or more than that two, you know, two to 2.5 grams per kilogram it's just, it's a lot of strain on the kidney because again, the kidney's job is to filter the blood. So if there's an excess of anything, protein, sugar, electrolytes, something that's in excess, the body's gonna see it as unnecessary and the kidney's going to excrete it, but it's just doing more work. It's just doing more filtering. And the kidney, like the heart in any part of the body can't work, work, work, work, work, eventually it's gonna get tired. So it is a balance. And that's where, you know, if you have questions about how much protein is safe. It really depends on your risk factors and your risk factors, your athletic needs. And so it's not a one size fits all. There are ranges of protein intake and again, age matters. You know, post-menopausal women, you know, may, you know, the age does matter. So it's a, it's a combination.

Kerry:

Yeah, I mean, definitely anything in excess we know is not great and our, our bodies are this big balancing, I guess, production that has been created that's actually amazing everything that it does. And you know, I think it's pretty exciting that it can handle these things, but eventually over time it's gonna, you know, like they'll pitter out like you had said. So what about supplements?'cause we obviously hear a lot about creatine, the supplement that a lot of athletes to consume, and there's even, you know, some exciting evidence that it might be helpful for some other things. So tell me about that and how that affects the kidneys.

Raeeda:

Yeah, this is probably one of the most common questions I get. Creatine supplementation and creatine has been studied for decades and it's safe most of the time for most people. I think people confuse creatine with creatinine? Just the terminology. And so creatine is the supplement. It, you know, in the original, when people start taking it, they might have a little bit of weight gain, which is usually water weight, but it is used to build muscle in athletes and it's used and build muscle in elderly people. So it, it's it is safe if athletes wanna take it i'm okay with it. We monitor their kidney function. We, we know what their urine, you know, protein levels are and what their kidney function baseline is. And that's another big thing that I do want everyone to understand is to understand what their baseline is because everyone has a little bit of a different baseline blood pressure even kidney function. If there's, there's a. We're unique. We're all unique, so we all have a different baseline.

Kerry:

What so tell me what is the difference? You said one's a supplement, one's a lab value. What happens if you're taking it? What happens to the labs? Does that, does it, is it scary? Or tell me more about that.

Raeeda:

So taking creatine supplements will not affect your kidney function unless there's something else going on. If you're taking a dramatic amount, if you're adding something else to it, that's, you know, so it's usually not the creatine, it's something else that may be causing kidney problems. It, you happen to might be taking creatine, but it's, the creatine will not change your creatinine number on the blood test. So that sometimes is a question.

Kerry:

Yeah, that's enlightening because I definitely have had, you know, patients where they're coming in normal GFR, but they are taking the supplement and they do have a little bit higher creatinine. So that is a myth.

Raeeda:

It's not that its a myth, it's just they're, they it's not due to the creatine, it's due to something

Kerry:

Mm. Okay.

Raeeda:

Probably it's not due to the creatine. That won't raise the creatinine

Kerry:

Mm-hmm. Mm-hmm.

Raeeda:

something is happening, so maybe it's you know, it, it could be anything. It could be their hydration status that day, and the kidney function is very much, very dynamic, that repeating it on a healthy day is the most important first step.

Kerry:

Yeah, and a lot of patients do go in there dehydrated. They think because you're maybe fasting for other parts of the labs that they can't drink water. I'm always like, no, please drink water. You also wanted the blood to actually be able to come outta your arm. So hydrate, right? So what what is a safe amount of creatine supplement?

Raeeda:

you know, there's two to three grams, I would say for most people, yeah.

Kerry:

I would say most of those scoops are like five grams or so. I've, in, in the liter, like what I've seen is five grams recommended for men, maybe like three to five for women, depending upon whatever their

Raeeda:

And I do recommend starting and ramping up slowly ramping up. So two to three maybe on the first, you know, week and ramping up three to five for women like you mentioned.

Kerry:

do you, what do you recommend ramping?

Raeeda:

It's not, not because of the kidney problem, it's more about the bloating or the feeling full. That more of the fluid buildup.

Kerry:

Mm-hmm. Okay. Yeah. Any other supplements that you often see in, you know, athletes that may affect the kidney?

Raeeda:

It is not a supplement, I would say, but just different caffeinated beverages. So some people might take, may just drink coffee, some people might drink Red Bull, some people, you know, different caffeinated beverage. And it's just to understand and remember that caffeine makes you urinate.

Kerry:

Mm-hmm.

Raeeda:

You, the more you drink of the, whatever the caffeinated beverage is, the, you're losing the fluid that you just, you know, filled up with the water bottle. So just that it'll be counteracting. So reducing the amount of caffeine will help you stay hydrated longer. Mm-hmm.

Kerry:

I just, that just made me think of another thing that some athletes do diuretics. So how can that, well, why do you think people use them, and then how can that affect the kidneys?

Raeeda:

So for a lot of athletes, they have to make weight, to play or, you know, to compete. And water weight is the fastest way to lose weight on a scale. And so that's, that's maybe one of the reasons that diuretics are, are used and diuretics get rid of water and salt, and they literally deplete your bloodstream, your body. You can lower your blood pressure if it's persistent. It can certainly cause kidney damage if it's again, persistent. And then taking a diuretic and then training, you're really at high risk of getting a kidney problem from dehydration.

Kerry:

Why don't we talk about over hydration in athletes? Yeah. Tell me. Tell me about that.

Raeeda:

Yeah. So in my endurance athletes, the one marathon runners particularly hydrating is important, but hydrating with the appropriate fluid that has electrolytes, salt, particularly in it, is very important because as we sweat, sweat has both salt and water. If you're running a marathon, you're losing salt and water, and you have to replete both salt and water. If you only drink water, that sodium level concentration gets diluted down because the water goes up. And when that happens acutely in a three, four hour period of time of a marathon the brain cannot adjust. There's not enough time for the brain to adjust kidneys working and working, working, trying to get rid of that excess water. But the it's just not fast enough to adjust and that brain symptoms the neurologic symptoms can be nausea, headache, but can progress to seizure and, and coma. And so that is a, a, a big thing for marathon runners that having getting rid of water stations actually has improved this condition of hyponatremia, which means low, low blood sodium levels and drinking to thirst, not just drinking just because. And I think, you know, a lot of us drink just because, because we're sitting at the table and we drink some water, and that's, that's okay for most of us because we can get up go to the bathroom if we have excess water. But for our marathon runners who are going, going, going and sweating, losing that salt at a high rate they need to hydrate with salt in their water, electrolyte, rich fluids. And I, I get that question a lot too, about what is an electrolyte rich fluid and what's, what's good and what's, what's not. I can say that they, they work and they work very well because I've taken some different brands myself to, to test them out on Hot Days. And if you have normal kidney function and you drink a a eight ounce cup of any kind of the different brands of electrolyte drinks

Kerry:

LMNT or

Raeeda:

or Liquid IV or drip drop or any of them. You drink it quickly, 30 to 45 minutes later, you'll be in the bathroom getting rid of it, because unless you are in a very dehydrated state. So, the way that these drinks work the best is by sipping them slowly over time, either in preparation of going out into the heat. Or throughout the day if you are outside in the heat. Because if you take it all at once, your kidneys will sense an excess of salt and get rid of the excess salt and then with that comes water. So it doesn't really help very much if you take it, if you drink it too fast. If you drink it all at once,

Kerry:

Unless maybe you're replenishing after the, the marathon or anything, or no,

Raeeda:

you can. Yes. It is just you should be replenishing during the marathon too.

Kerry:

Well that's true.

Raeeda:

Yeah.

Kerry:

Yeah. I'm glad you brought that up'cause I was actually gonna ask that next about the hydration drinks that we see everywhere. Who are they safe for? Who are they not safe for? And so basically if you're saying you have normal kidney function and you drink it more slowly, you should be able to be perfectly fine. You know, getting those electrolytes and excreting what you don't need. Is that correct?

Raeeda:

Correct, yes. For healthy people, for people who have kidney disease, they have to be a little more careful because the kidney cannot excrete or get rid of the salt water, potassium that are in the electrolyte drinks as easily. And so retaining salt can raise your blood pressure or retaining potassium can cause arrhythmias through the heart. So, so usually it's for people who are really advanced kidney disease and, and they know that they have kidney disease. I, I would hope most people at the, they're advanced, they would know that they have kidney disease. And so those are the people who I say don't drink an electrolyte drink.

Kerry:

Mm-hmm. So. The average patient that may have high blood pressure, but their kidney function is okay. What would you say about, for that kind of patient, because we always hear, you know, about a dash diet or a low salt diet for blood pressure. What are your thoughts on that?

Raeeda:

Well, again, I would only recommend it for a certain event or a particular time. They're going out in the sun. They know they're gonna be out. They have high blood pressure. Those are the people. Yes, I could. I would say that's, that's okay,

Kerry:

Mm-hmm.

Raeeda:

but not for everyday use.

Kerry:

Any comment on Gatorade products, those kind of things?

Raeeda:

Yeah, I know you're Tampa Bay, right?

Kerry:

Yeah.

Raeeda:

Gatorade is, is a, is a good drink. It, it does have a lot of sugar. That's maybe the knock on it. But you know, it does work as a, as a electrolyte rich drink. But there are other ones as well.

Kerry:

Is there any like, damage to the kidney? Like maybe with like the marathon runners and things like that, if there's like too much sugar in the, like supplements, like I say, they were drinking Gatorade or is there is not, is that not gonna affect kidneys so much,

Raeeda:

It's not gonna affect kidneys on the short term basis. It's more if you know they had diabetes.

Kerry:

Mm-hmm.

Raeeda:

Which can affect the kidneys, diabetes and high blood pressure are the two most common causes of kidney disease in America. And so, know, one or two times it's not gonna affect the kidneys. It's just the more

Kerry:

Yeah.

Raeeda:

repeated, repeated uses of Gatorade or any other sugar, high sugar product will affect the kidneys long term.

Kerry:

Mm-hmm. I'm not thinking of any other more specific like supplements or anything like that. Is there anything that you can think of that we didn't discuss that you see sometimes?

Raeeda:

I think those are, they're, it primarily is the creatine and then like just the caffeinated beverages.

Kerry:

Mm-hmm. And then obviously electrolytes and pain medication and diuretics and anything else like that or think we kind of covered it.

Raeeda:

Yeah, for the the average person. The average athlete, yeah. Those are the,

Kerry:

cool. All right, so how about what are some early like red flags that the kidneys might be under stress? I think you already mentioned one, but let's kind of review that and then yeah.

Raeeda:

So blood in the urine. It could be red, it could be maroon, it could be brown. That is all considered blood in the urine. Could be a sign of a new problem, or it could be a sign of a, a, a chronic problem, but most of the time it's a new problem and it needs evaluation to determine if there's a inherited problem or if it's a muscular problem of the, of the muscle breakdown, as I mentioned. Or is it due to an infection? A recent, like sore throat, for example. Lots of reasons. Or, or it could be a bladder problem. Or a kidney infection, a regular urinary tract infection. So it really depends on the person, what's going on with them. Are, were they active in training just now, just recently or are they having fevers and chills or what's going on with them clinically and then other symptoms? It is such, it's such a strange word, but it it's is foamy urine is, is it's a strange symptom for somebody to bring up. But if, if you, as the physician bring it up, they're like, oh yeah. Because I mean, nobody notices it or even knows to notice it. And that's the thing. Foamy urine can be a sign of, of a protein spillage in the urine and protein spilling in the urine can be again, from diabetes, from high blood pressure, from any kind of strain on the kidneys. It could be new or it could be going on for weeks or months, but it's important to know that if you have foamy urine, that you get checked to see if you have protein in the urine. Why? And then what can we do about it?

Kerry:

Is there any like correlation just to dispel a myth, if there is one of eating too much protein and having protein in the urine?

Raeeda:

Usually it's not that easy to correlate that, that, that much. It's, again, it's multiple insults that would cause the protein in the urine or, and also extended period of time. It doesn't just usually happen one day, and then you have protein in the urine because our kidneys, our bodies are so, such, such amazing capacity to compensate and take care and repair all the damage that we do to ourselves.

Kerry:

Yeah. So you mentioned the glomerular filtration rate. You mentioned the protein in the urine. We talked about the creatinine. Are there any other lab or monitoring things that we kind of look at with the kidneys?

Raeeda:

So electrolyte levels are important. Potassium, magnesium and sodium are the ones that I look at. The most people with kidney disease already may have problems with their bone health because the kidney is responsible for making sure bones are strong bones. So calcium, phosphorus and vitamin D. Those three levels we, we check off, often. And those can start to become abnormal in people with a more advanced kidney disease. Another blood test would be your hemoglobin, your blood counts. The kidney's job is also to produce a hormone that tells the bone marrow to make new red blood cells. And when this hormone is low because you have kidney disease. People can develop anemia and feel fatigued and have poor energy.

Kerry:

Mm-hmm.

Raeeda:

So these are all the complications of kidney disease that I look for when I see a new patient. And hopefully they're not there, but if they are there, I start to see if we can reverse those.

Kerry:

Mm-hmm. What is one daily habit that can support kidney health and pain-free performance?

Raeeda:

I would say starting with having a hydration habit. Just get a bottle, a two liter bottle. It doesn't have to be full two liters, but get a two liter bottle that you can start with, even one liter, but just make it, get a two liter bottle. Fill it up the night before have it on your counter as soon as you leave the morning. And, and, and and just take it with you throughout the day in the car, at work, whatever you're doing dropping off kids, picking'em up after that. Just, yeah, it's funny story is that I, I did that too and I realized that I, sometimes I would come home with a full water bottle still to open it and drink it. But yeah, my, even my five-year-old car called me out on that. So

Kerry:

Yeah. I try

Raeeda:

it here

Kerry:

get a one liter bottle done before I leave my home because I know that I'm gonna be like, busy in clinic or something like that and not get all of that down. So that's usually my goal. At least get that, you know, one in the morning. And I think that's, you know pretty decent advice, but not everybody can chug water like me, so, yeah. But I get, I think that I already knew you were gonna say that. Of course, but that's excellent advice.

Raeeda:

I would,

Kerry:

about, oh, go

Raeeda:

was just gonna say that if you're starting a fresh water, a habit and you haven't really drank that much water, that's why I, I mentioned about getting a two liter bottle, but just fill it up only one liter because your body hasn't adjusted to drinking so much water. And so when I started doing it myself at one and a half liter, I was like, I'm good. I'm full. I don't wanna drink anymore. And, and you just have to listen to your body. That means your body's not ready to go to two liters, and that's okay. But it's important to just listen to your body, don't follow a fad, or this is what you have to do. And our bodies are designed to teach us and tell us.

Kerry:

So speaking of fads, some of them are like, you know, half your body weight and water or drink till your urine is clear. What do you think about those?

Raeeda:

I get scared when I hear those. Yeah, there's like the 75 hard, I think, and that's like four liters of water and, and so if you are thinking about starting a new regimen, whether it's drinking water, whether it's exercising, and if it seems a little bit out of the norm, speak with your physician. See if it's safe for you and, i'm not saying you don't do it because you, you, and maybe it's okay, but find out more, do some research, find out more. Talk to your physician.

Kerry:

Yeah. So I will say, for example, when I was, I remember training younger years for soccer, they always used to say, if you were gonna drink something with caffeine, like a soda or something like that, to always counteract it with like the same amount of water. You think that's good advice?

Raeeda:

Yeah, I think that's, that's reasonable. It makes sense. It's just again, about the timing

Kerry:

Mm-hmm.

Raeeda:

you do it and how much can you drink at one time. Volume wise.

Kerry:

Mm-hmm. Okay.

Raeeda:

But yeah, I think it's reasonable.

Kerry:

How about for listeners who aren't athletes, any practical steps they can take to keep their kidneys healthy and strong?

Raeeda:

I think it's the same, you know, get that water habit and making sure that you are also getting up to take a water break meaning, or to take a water break and then also take a, a bathroom break. Sometimes we like hold our, our urine. We're so busy, busy, busy, and we don't even have a chance to go to the bathroom. And it's important. To get rid of the toxins. Our body is getting rid of it, and you just let the body do its thing.

Kerry:

Yeah, that's a good point. It's also not that healthy to hold your urine for a long period of time. So how do you educate teams, coaches, athletic organizations about heat safety and kidney protection, like currently within your practice and everything?

Raeeda:

So I am, creating a course for athletic trainers on heat safety, on rhabdomyolysis, on hyponatremia, exertional hyponatremia. So to really, to really help them understand what to look for, the signs and symptoms, the early intervention, and that they feel confident in calling it and asking for help and saying, this kid doesn't look good, or This, you know, athlete doesn't look good. I did this, this, and this. This is the next step. So just to bring them to a higher threshold, to be able to take the first few steps on the field. I want that, that is, that is my, you know, my mission to be able to bring that sort of, again, it's awareness of all the people who are responsible for athlete health. Starting it could be the parent of a student athlete. It could be the coach, it could be the athletic trainer, it could be the, the, the team physician the owner of the team, you know, depending on where you're at. And really to, to understand that this is not, that athletes shouldn't have to choose between their performance today and their long-term health. Or their career longevity, they should be able to have both.

Kerry:

Do you think there's like gaps in like the education with this in like the National Academy of Sports Medicine and the other one? I can't remember the other abbreviation. You think there's some gaps there?

Raeeda:

I do feel like, again, that we in medicine put kidney health after the fact that we only talk about the kidneys after there's a problem. We only bring in the kidney specialist because creatinine is red in the computer and it's just that is that's been how it's been for years. And so I certainly, that's, that's all of medicine. So certainly in sports medicine I think it's, it's just a new area that I'm hoping to bring awareness to. And the more physicians, sports medicine physicians athletic trainers, coaches, I can, I can speak to better.

Kerry:

Given that comment, when should like someone like myself, like in primary care, be referring to you?

Raeeda:

So I would say, you know, anyone who has multiple risk factors for kidney disease starting to have that conversation.

Kerry:

Mm-hmm.

Raeeda:

with the, with the patient that understanding that, okay, that they have diabetes, they have high blood pressure, they have high cholesterol, they have, you know, they might be an athlete already or they're just, they're active person, they wanna be proactive on their health. Having the conversations of, let's do a screening test to see where you're at. Just like we have screening tests for, we have mammograms, which is a screening test for silent breast cancer, we have kidney, you know, kidney disease is silent. There are no symptoms until it's all the way progressed. So that a, a urine protein ACR albumin to creatinine ratio and a blood test to look for a kidney function. Those two screening tests are just to see where a person is and to see if they have any kidney disease, and then if they do what stage they're at. And so usually you know, I like to see people at, at least at stage three, I know people can stay in stage three for a decade, and, and that's okay. I can see them once and sort of again, give them that education and, and preventative guidance. And then they can not see me hopefully again. Ever or for 10 years, or, you know, so I like to see people earlier because I'm, I'm, I when I, when I have limited options to help somebody, it's, it's not fun.

Kerry:

I'll say, when I've inherited people from like another doctor, it's always interesting to me that they are not aware of their chronic kidney disease diagnosis. Like nobody ever told me that. Nobody ever told me that, but it's in their chart. Or to me it's pretty obvious just looking at the labs. So I think actually knowing what. If you have something wrong with them to know, so, hey, you should be monitoring and avoiding certain, you know, medications, things like that too. So, you know, just being more conscious that you have this thing that needs to be watched a little bit closer. Right. I think is a very important.

Raeeda:

I think, yeah, just empowering our patients to, to be curious and to ask why is this abnormal? Is it abnormal? What is, what do I have to do? What, what can I do? Um, so yeah, from the physician side and then also the patient side of that, it's a team. It's a team effort,

Kerry:

Yeah. Yeah. So what is your favorite health tip for our listeners today?

Raeeda:

I would say I mean, I tell this to all my patients and to my family that to know your blood pressure. All of us have a different baseline. All of us our blood pressure changes throughout our, our life and just so many people don't know what their blood pressure is, so if there's a problem, they don't know what it used to be. So just like kidney disease, high blood pressure is silent. There are no symptoms until you're already in the ER with a headache and having a stroke or you're in the ER with chest pain and having a heart attack. And so. If you're starting a new exercise regimen, check your blood pressure beforehand so you know what your baseline is. So you know, two weeks later you're getting a headache or something doesn't feel right. You know what it is. If you're a female athlete and you're thinking about getting pregnant, or in the next year or so, know what your blood pressure is today so that if you become pregnant and you have high or low blood pressure. Which can affect the kidney function during pregnancy as well. We know what we can do and, and if this is a new problem or was it an old problem. So yeah, I think just, again, knowing your blood pressure, go to the drugstore, buy a, buy a cuff, or just go to the drugstore and put your arm in one of those things and, and know what your number is.

Kerry:

I'll throw this in there validate bp.org gives you much better blood pressure cuffs, some that are kind of like FDA approved, so I would recommend getting one from there. Preferably one that goes on the arm if you can too. So that's really good advice. One other thing that you had said was peak performance only comes with peak health and that includes your kidneys. So I think that's also some good advice to the athletes out there as well. And then I wanted to ask where can people find you if they wanna follow you, work with you or, you know take your athletic training course.

Raeeda:

Yeah. So the best place is our website, sports nephrology.com. So it's sports N-E-P-H-R-O-L-O-G y.com, and you can put it in your show notes. And we have a newsletter. It's only monthly. I don't like to inundate my people, but just we give some wellness tips. And we, if you'd like to book a, a free call or a consultation, I'll have a a coupon code for 15% off a first consultation. And we can put that in the show notes as well. On social media, I am the kidney queen, as we mentioned on Instagram and have a YouTube channel. And then I'm Sports Kidney Coach on TikTok.

Kerry:

You are everywhere. You got it all covered.

Raeeda:

Yeah.

Kerry:

Very

Raeeda:

Well, I also wanted to mention, you know, I know your, your people in Tampa Bay. I see clients all over the country, and I have international clients as well, where I, again, give education and preventative guidance to everyone with my knowledge. I'm only a doctor for you if you're in Texas where I'm licensed.

Kerry:

Awesome. Awesome. Well, that is such great information. We will put everything in the show notes and everybody, thank you so much for tuning into this week's episode on the Get Healthy Tampa Bay podcast, and stay tuned next week for next week's episode. Thank you.

Raeeda:

Thank you so much.

Kerry:

Thank you, Dr. Gheewala.

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Dr. Kerry Reller

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