Friday Q&A: sepsis; peptides; kidney stones; and chronic back pain

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The following questions have been lightly edited for length and clarity.

QUESTION #1: SEPSIS

Dr McBride, I saw the news last week about the tragic and sudden death of Kyle Busch, who was a seemingly healthy person, from Sepsis. What is this specifically? Can it really happen to anyone?! I can’t stop thinking about it now!

—Alex

Hello Alex,

My heart goes out to Kyle Busch's family. I read, too, that he was 41 years old and was gone within days of what appeared to be a respiratory illness. It’s the kind of story that stops you in your tracks.

I was on call for my practice last weekend and was reminded how rapidly sepsis can come on. It happens when a bacterial infection that would normally be contained (for ex. a urinary tract infection, a skin infection, a pneumonia) triggers a cascade of inflammation that spirals out of control and shuts down vital organs. When that happens rapidly, it can be fatal within hours even in previously healthy people. (So when your doctor insists that you go to the ER on a weekend, please don’t shoot the messenger! 😅)

So yes, sepsis can happen to anyone, but possible doesn’t mean probable. For most healthy middle-aged adults, sepsis remains uncommon, especially if you get run-of-the-mill infections treated appropriately and early. Certain factors increase the risk of sepsis significantly, including age (older adults and very young children are more vulnerable), a compromised immune system, diabetes, kidney or liver disease, medications that suppress the immune system, and having had a recent surgery or hospitalization.

The reason outcomes vary so dramatically comes down almost entirely to how quickly it’s recognized and treated. The signs to watch for include a high or unusually low temperature; rapid heart rate, confusion or altered mental status; difficulty breathing; or the sense that something is very wrong. Especially in the context of a known or suspected infection, those symptoms should prompt an immediate trip to the emergency room, not watchful waiting at home. When in doubt, call your doctor. I hope that helps!

QUESTION #2: PEPTIDES

Hi, I keep hearing about peptides being touted for everything from injury recovery to anti-aging to weight loss. A lot of it is from some of my favorite influencers online. What are peptides actually? Do they work the way they are being promoted?

-Christine

Hi Christine,

I wrote an article on the peptide craze here. Peptides are a perfect example of the wellness industry running wild with a biologically plausible concept and selling it as something bigger than the evidence supports.

Here’s the deal: Peptides are short chains of amino acids that act as signaling molecules in the body. Your body makes thousands of peptides daily. Insulin is a peptide. GLP-1, the mechanism behind Ozempic, is a peptide that our own body makes, too.

But what wellness influencers are typically promoting is not the set of FDA-approved peptide drugs that have gone through years of rigorous clinical testing in humans before reaching patients. The peptides being sold online—BPC-157, TB-500, and others—are enjoying a moment in the sun thanks to wild success of GLP-1s. But these non-FDA approved chemicals are often experimental compounds not approved for human use, often sold as research chemicals with disclaimers that they’re “not for human consumption” while simultaneously providing detailed instructions on how to inject them. BPC-157 (one of the most popular) has around 36 studies in the published literature—mostly in rats!—and just a handful of tiny, uncontrolled human studies. That's a thin evidence base for any clinical application in humans.

Peptide science is evolving. Right now it’s early and very unregulated, and the gap between what the research shows and what influencers claim is enormous. Until we have more safety data and human studies, I suggest saving your money and sticking with evidence-based ways to age with intention and recover from injuries.

I hope this gives you some clarity on the situation!

QUESTION #3: KIDNEY HEALTH

I'm 64 and had a kidney stone two years ago (the most painful experience of my life!!) Since then I've been drinking more water and watching my diet, but I realize I know almost nothing about how my kidneys actually work or what I should be doing to protect them long term. How do I protect my kidneys, beyond avoiding kidney stones?

-Celia

Hi Celia,

Kidneys are easy to ignore until something goes wrong, and there’s nothing like kidney stone to get your attention—ouch!!

The kidneys do a LOT more than most people realize. I consider them the smartest organs in the body. They filter about 200 liters of blood a day, regulate blood pressure, balance electrolytes, control fluid levels, and produce hormones that support red blood cell production and bone health.

The most important things you can do to protect them are also, not coincidentally, good for your overall health. Blood pressure control is #1. Chronic hypertension is one of the leading causes of kidney damage and does its work silently over years. (Here is my conversation with cardiologist Dr. Greg Katz about blood pressure control.) Blood sugar matters too, even if you don’t have diabetes. (My article on pre-diabetes is here.) Other key kidney tips: staying well hydrated and avoid regular use of NSAIDs like ibuprofen and naproxen (the kind of thing people take routinely for back pain or headaches). These can be hard on the kidneys, particularly at higher doses and over time.

As for what to ask your doctor: beyond routine labs, it’s worth asking about your blood pressure trend over time, your blood sugar, and whether a kidney stone workup was ever completed. Those three conversations cover most of the meaningful ground. Does this help?

QUESTION #4: CHRONIC BACK PAIN

Dr. McBride, I've been dealing with chronic back pain for years, and my doctor keeps offering opioids, which I don't want to take long term. I've tried physical therapy with mixed results and ibuprofen only does so much. Do I have any other options?

-Jerry

Hello Jerry,

Your instinct to avoid long-term opioids is smart. It also sounds like you have more options than you’re being offered. Some ideas: if ibuprofen isn’t getting the job done, ask about a COX-2 inhibitor like Celebrex. It targets inflammation more selectively and is easier on the stomach. Topical diclofenac gel, applied to the area that hurts, delivers anti-inflammatory relief locally with minimal systemic effect. And if your pain has a nerve component, medications like gabapentin or duloxetine work on the pain pathway differently than anti-inflammatories and can make a real difference.

On physical therapy: mixed results often reflect a mismatch between the type of PT and the type of pain, not evidence that PT doesn’t work. It may be worth trying another physical therapist or even a physiatrist (a physician specializing in physical medicine and rehabilitation) for a more thorough assessment and plan.

Interventional approaches like epidural steroid injections, nerve blocks, or radiofrequency ablation are legitimate tools, and they’re often offered later than they should be. Finally, don’t dismiss cognitive behavioral therapy designed specifically for chronic pain. It has strong evidence behind it, not because the pain is imagined, but because chronic pain reshapes the brain in ways this kind of treatment can address.

The upshot: opioids aren’t the only road forward. Ask your doctor about a referral to a pain specialist or physiatrist who can build a multi-modal plan with you.

Don’t miss out on Book Club! Sign up close May 31st!

Join me this summer for the official Beyond the Prescription Book Club. It’s open exclusively to Substack readers and gives you early access to the book. Sign-ups close on May 31st!