An Integrative Medicine Approach to Cardiovascular-Kidney-Metabolic Syndrome

Cardiovascular disease (CVD) contributes to one in five deaths in the US and kills over 17 million people around the globe each year. These conditions affect the heart and blood vessels, including coronary artery disease, stroke, heart failure, and arrhythmias.

Emerging science shows the interconnections between metabolic health, kidney disease, and diseases that impact the cardiovascular system. The American Heart Association has described the term Cardiovascular-Kidney-Metabolic (CKM) Syndrome to describe this systemic disorder that involves interactions among metabolic risk factors, chronic kidney disease, and the cardiovascular system. This condition impacts nearly the whole body, contributing to multi-organ dysfunction and a high rate of adverse cardiovascular outcomes.

While this condition is becoming increasingly common, with around 40% of adults in the United States having CKM, there are steps that you can take to reduce your risk and bring your body back into balance. Integrative medicine offers a comprehensive understanding of CKM Syndrome and holistically managing this wide-reaching condition. 

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Defining Cardiovascular-Kidney-Metabolic Syndrome

Individuals with Cardiovascular-Kidney-Metabolic (CKM) Syndrome can have established cardiovascular disease due to metabolic risk factors like diabetes, obesity, and/or chronic kidney disease or experience complications of their CVD due to these factors. CKM also includes individuals who have metabolic risk factors and/or chronic kidney disease that put them at an increased risk for cardiovascular disease. 

This condition is increasingly common, with 1 in 3 adults in the US having at least three risk factors that contribute to CVD, metabolic disorders, and/or kidney disease.

Together, these conditions result in increased poor health consequences that are greater than each of their individual contributions. If you have more than one of these conditions, it multiplies your risk of severe health consequences, especially poor outcomes due to cardiovascular disease. 

When you have excess fat tissue and/or fat in places it shouldn’t usually be, like the liver, it causes changes throughout the body. The metabolic dysfunction seen in CKM, such as type 2 diabetes and obesity, results in changes to blood flow, increased inflammation, fibrosis of tissues, and metabolic derangement. Over time, these physiologic changes cause end-organ damage to the heart, kidneys, and blood vessels. 

The Role of Integrative Medicine in CKM Syndrome

Integrative medicine considers the whole person's history, lifestyle, genetics, and current health issues. This approach focuses on the person as a whole and looks at opportunities for prevention and holistic care. 

A holistic approach to CKM management assesses a person's risk factors and looks at underlying factors contributing to disease. This allows for an individualized management approach that addresses opportunities for preventing future disease while effectively addressing current imbalances in the body, mind, and spirit. 

A staging system has been developed for CKM syndrome to best support prevention across the lifespan. This system considers the underlying pathophysiology of this condition, risk factors, and opportunities for prevention and care. In the early stages of the disease, people start to have unhealthy fat distribution and metabolic dysfunction that later progresses to heart or kidney issues. 

In stage 0, a person has no known risk factors for CKM. 

In stage 1, excess or dysfunctional fat tissue creates increased inflammation and oxidative stress in the body, damaging tissue and reducing insulin sensitivity. 

Once someone shows more advanced metabolic risk factors like elevated triglycerides, high blood pressure, type 2 diabetes, and/or metabolic syndrome and/or develops chronic kidney disease, they are classified as having stage 2 CKM. 

The next stage of CKM, stage 3, involves early subclinical stages of cardiovascular disease with CKM syndrome or an increased predicted risk of cardiovascular disease or very high-risk chronic kidney disease. 

In the final stage of CKM, stage 4, total clinical cardiovascular diseases like heart failure, heart attack, or stroke develop.

Throughout this progression, integrative medicine for CKM Syndrome combines conventional medical approaches with complementary therapies to address the multifactorial nature of this condition. This approach empowers people to take charge of their health and work with a team of healthcare professionals to implement a management plan that addresses the interconnectivity of metabolic, kidney, and cardiovascular health and the interconnectedness of the person and their lifestyle, environment, and social system.

Functional Medicine Testing in CKM Syndrome

These conditions share risk factors that lead to dysfunction in the body. Functional testing for CKM Syndrome helps uncover risk factors contributing to imbalances in the body to target the most effective strategies for regaining balance. Functional medicine testing helps assess risks in CKM and provides crucial information about individual factors, including genetic predispositions, nutritional deficiencies, metabolic derangements, and hormonal imbalances.

Risk factors like high blood pressure, elevated triglycerides, fat deposition around the waist, micronutrient imbalances, and insulin resistance lay the groundwork for CKM syndrome. These risk factors can be evaluated with a physical examination and functional medicine laboratory blood work.

For example, metabolic health can be evaluated by looking at blood sugar balance using fasting glucose and hemoglobin A1c, which measures the average blood sugar level over the previous six weeks. It is also essential to consider insulin levels and functioning by evaluating fasting insulin and C-peptide levels, a marker that the body produces insulin. 

A lipid panel by Access Medical Laboratories measures total cholesterol, HDL ("good" cholesterol), LDL ("bad" cholesterol), and triglycerides to evaluate the balance of fats in the blood. To more specifically consider CVD and metabolic risks, lipoprotein(a), LDL particle number, and ApoB-containing lipoproteins (ApoB) can be used.

Nutrient deficiencies and imbalances can also contribute to high blood sugar, weight imbalances, and insulin resistance, so the SpectraCell Micronutrient test can evaluate levels of specific vitamins, minerals, and other nutrients in the body. 

To look at many of these markers together and additionally consider how hormones impacted by fat, like leptin and adiponectin, are affecting metabolism, the Metabolomic Profile from Doctor's Data is valuable. 

Similarly, Genova's NutraEval FMV provides insights into how the body handles oxidative stress, how cells function, and toxin exposures, which can all impact metabolism.

Evaluating these risk factors helps to identify metabolic syndrome, type 2 diabetes, and obesity, which in turn can cause inflammation and oxidative stress in the body that can worsen kidney and heart function. 

A functional medicine test that reflects inflammation is high-sensitivity CRP. The liver makes this protein in response to inflammation, and it can be used over time to track trends in inflammation resulting from the metabolic imbalances involved in CKM Syndrome.

Kidney function can be evaluated with several functional medicine tests. A comprehensive metabolic profile (CMP) measures various substances in your blood, including waste products filtered out of the blood by the kidneys–BUN (blood urea nitrogen) and creatinine–along with levels of electrolytes, glucose, and proteins, that can give a picture of how well the kidneys are doing their job. This testing also assesses the glomerular filtration rate (GFR), which reflects how well the kidneys filter waste products from the blood.

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Nutritional Interventions and Dietary Strategies

Nutrition strongly influences the heart, kidneys, and metabolism. Dietary approaches are effective in helping to prevent and control metabolic dysfunction like metabolic syndrome and type 2 diabetes and have significant impacts on kidney and heart health. 

A diet high in fiber, vegetables, legumes, and other high-quality proteins like wild fish and grass-fed meats has positively impacted many of the risk factors associated with CKM Syndrome. This anti-inflammatory way of eating can help you maintain a more balanced weight and fat distribution, prevent insulin resistance, and improve markers of inflammation and fat and sugar metabolism. Eating high-fiber and complex carbohydrates with a lower glycemic index instead of processed carbohydrates and added sugars helps keep blood sugars balanced.

Following a Mediterranean diet is one way of incorporating this dietary approach to managing and preventing CKM Syndrome. This approach provides optimal nutrition for CKM health by emphasizing citrus fruits, vegetables, legumes, and complex carbohydrates with moderate fish and olive oil. Science shows that it helps to improve blood sugar, insulin, and cholesterol, favorably impacting metabolism and inflammation throughout the body. Given how favorably a Mediterranean diet impacts blood vessel function, inflammation, fats in the blood, and blood pressure, it has been recommended for people with cardiovascular and chronic kidney disease.

Since a lack of adequate nutrients like zinc, chromium, magnesium, and vitamin D can contribute to metabolic dysfunction and blood sugar dysregulation, a nutrient-dense diet like this can help to deplete the body's needs. If nutrient deficiencies are found with functional medicine testing, targeted meal plans and supplementation can be individualized to improve levels. 

Lifestyle Modifications and Behavioral Changes

Lifestyle changes and habits can be powerful components of an integrative medicine approach to CKM Syndrome. Lifestyle modifications such as incorporating regular physical activity, obtaining and maintaining a balanced weight, reducing stress, and avoiding smoking can prevent progression and facilitate regression along the stages of CKM Syndrome. 

Lifestyle is indeed medicine and favorably influences many risk factors involved in CKM Syndrome. Research has shown that regular and consistent exercise favorably improves body composition by reducing abdominal obesity and improving metabolic dysfunction. Maintaining a balanced weight improves metabolic factors involved in CKM Syndrome, with studies showing that losing 7% of body weight can reduce insulin resistance and blood pressure and decrease the risk of diabetes.

Incorporate regular, consistent exercise like walking, swimming, and higher intensity interval training (HIIT) if a knowledgeable practitioner recommends that to improve your body's ability to handle sugars, keep your weight balanced, and reduce hormonally-impacting belly fat.

Other lifestyle changes for CKM Syndrome include managing daily stress and avoiding smoking. If you have uncontrolled chronic stress, it can be hard to regulate your metabolism even when eating a healthy diet and getting regular exercise. Ongoing stress and inadequate or disrupted sleep increase inflammation throughout the body, dysregulated blood lipids and sugars, and increase the risk of CKM Syndrome. Incorporate a meaningful practice for managing stress with mind-body techniques like yoga, meditation, breath work, or tai chi. 

These practices help to shift your body into a parasympathetic state where it can rest and repair so that you are not constantly activating the sympathetic nervous system stress response. Maintaining a regular sleep routine is also crucial since consistent quality sleep is needed for a long-term balanced metabolism. 

Another crucial behavioral modification for addressing CKM Syndrome is to stop or avoid smoking. This will reduce your risk of cardiovascular and metabolic diseases by helping to improve the balance of fats in the blood, balancing inflammation, and reducing the risk of metabolic syndrome. 

Complementary Therapies and Their Benefits

For example, acupuncture is a treatment used in Traditional Chinese Medicine (TCM) involving the insertion of tiny needles at specific points on the body to improve energy flow and support the body in healing. Studies suggest that acupuncture helps to improve metabolic risk factors for CKM Syndrome, such as fasting blood glucose and HbA1c levels. Acupuncture has also been shown to improve kidney function and even reverse some of the physiologic factors involved with CKM Syndrome, such as high blood pressure and blood sugars, dysregulated fats in the blood, obesity, oxidative stress, inflammation, and blood flow. 

Yoga, meditation, and other mindfulness practices are also valuable complementary therapies for addressing the risk factors involved in CKM Syndrome. Mindfulness practices use focused awareness of the present moment without judgment to reduce stress, anxiety, inflammation, and blood pressure, which has been shown to improve kidney function, metabolic markers, and CVD risk factors.

Various herbal supplements have also been shown to improve parameters associated with CKM Syndrome, such as blood glucose, insulin levels, and kidney function. Herbal supplements that may be part of an individualized protocol for addressing risk factors include curcumin, berberine, cinnamon, and gymnema, which can help balance blood sugar, lipids, blood pressure, and metabolism, as well as omega-3 fatty acids, which are associated with reduced cardiovascular issues.

Medication Management and Integrative Approaches

These complementary therapies can be part of a personalized medicine approach and medication management that considers individual patient profiles. This type of personalized medicine for CKM Syndrome utilizes proactive strategies for addressing the early stages of the disease and risk factors to prevent progression and end-stage complications. Interdisciplinary care looks at the various components of this syndrome and utilizes integrative medicine therapies to complement pharmacological treatments. 

A multidisciplinary therapeutic approach may incorporate medications that have some ability to treat several of the conditions that are part of the CKM Syndrome, including metabolic dysfunction/diabetes, kidney disease, and obesity. For example, SGLT2 inhibitors (Jardiance, Forxiga, and Invokana) and GLP-1 inhibitors (Wegovy or Ozempic) are often targeted at treating type 2 diabetes but also help promote weight loss and reduce the risk of kidney and cardiovascular disease. The specific choices of medications can be personalized to each person's unique needs and comorbidities. For example, SGLT2 inhibitors are often preferred for people with chronic kidney disease and metabolic dysfunction as part of CKM Syndrome since they can reduce the risk of worsening kidney function.

Individual risk factors may also be targeted, depending on an individual's overall health picture. For example, improving blood pressure significantly reduces the risk of many CVD outcomes. In CKM Syndrome, ACE inhibitors/ARBs are recommended for controlling blood pressure in people with diabetes and albuminuria or those with chronic kidney disease since they prevent worsening kidney function.  

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Cardiovascular-Kidney-Metabolic Syndrome: Key Takeaways

Cardiovascular-kidney-metabolic Syndrome is a chronic condition leading to poor health outcomes that involves the interactions between heart disease, kidney disease, and metabolic disorders like diabetes and obesity. Identifying risk factors for this condition at an early stage can allow for interventions that reduce the chance of progression and improve quality of life.

Integrative medicine provides a comprehensive and holistic approach to CKM Syndrome that looks at the whole person and her needs at all levels. Embracing integrative care for CKM Syndrome recognizes a socioecological framework that helps us more deeply understand the risk factors that contribute to CKM Syndrome and develop strategies to address these. 

Nutrition, personalized supplementation and medication protocols, and lifestyle measures to optimize weight and metabolic health are critical to embracing integrative care for CKM Syndrome. This holistic approach combines conventional medical treatment with lifestyle and complementary therapies to provide comprehensive care.