Kidney Disease! Is this The End?

Living Well With Kidney Disease

Recently I consulted Nikhil a 51-year-old man who was

• Diabetic (sugar levels in control now but with medications and slight diet modifications)
• Heart patient (3 stents)
• Blood pressure (in control now with medications)
• Central obesity (all the body fat was concentrated in the abdominal area)
• Overweight by 15 kgs

To add to this he did not exercise!

Plus a regular drinker and smoker in the past. Now it has reduced from 5 to 6 cigarettes a day to 1 and from 90 ml thrice a week to once

He has been diabetic for the past 12 years with uncontrolled sugar levels in the past. This had affected his kidneys. 

His blood reports of concern were:

Serum Creatinine – 1.56 mg/100 ml (Reference Range 0.5 – 1.2)

Serum Creatinine – 5.5 mEq/L (Reference Range 3.6 – 5.3)

Urine report

Glucose - (+++)

Protein – a trace

Urine:

Albumin:Creatinine ratio – 111.6 mcg/mg Creatinine (Reference Range 30 – 299 - microalbuminuria)

 So here is a man with a Compromised Kidney Function. And he wanted to enrol for my diet program.

Compromised Kidney Function

Now, there’s a misconception that any kidney disorder, particularly with high creatinine levels, means absolutely no protein in the diet. If potassium levels are out of range, then no fruits also! Only select vegetables are permitted and that too after leaching. Also, water is restricted to one litre only! High potassium cereals too are banned.

So, what does he eat? He is a vegetarian. To make matters worse, pulses and legumes have high protein as well as potassium content!

Now as I have just mentioned, Nikhil has a compromised kidney function, he is not a CKD (Chronic Kidney Disease) patient. So what does one do with someone with a compromised kidney function?

My Approach

To begin with, I asked him to stop smoking and drinking completely. Tough but has to be done. The idea is to stop further damage to the kidney. Also, regular exercise and breathing exercises is an integral part of the process to improve circulation and improve the functioning of the kidneys. A kickback would be fat loss.

So coming to his diet, protein is to be restricted; not eliminated. Low potassium fruits (especially apples and pears) are allowed. Vegetables with low potassium levels (varieties of cabbage and gourd except bitter gourd) are recommended while the high potassium ones are restricted and that too only after leaching. The very high potassium level veggies like root vegies and greens (though little fenugreek leaves are allowed sometimes in restricted amounts) are to be eaten very rarely and only after leaching. Low potassium grains like rice and barnyard millet are allowed. And water is slightly debatable. It could be a maximum of 2 or the normal 2½ litres.

But there’s a problem! At times, the protein and potassium content of the pulses, legumes and grains might leave you confused. A comparatively low-protein cereal or dal may come with high potassium content and vice versa.

I resolve this by focusing on the potassium content. The average Indian does not even come close to the daily requirement of protein (0.8 or 1 gm per kg body weight).

So lentils and, dairy products in restricted amounts because of their high protein and potassium content. I recommend Masoor (dal and whole) and Chana (dal and whole). Pulses to be eaten very occasionally.

Let us look at kidney disorders in more depth. What exactly is it?

Kidney disease can affect your body’s ability to clean your blood, filter extra water out of your blood, and help control your blood pressure. It can also affect red blood cell production and vitamin D metabolism needed for bone health. When your kidneys are damaged, waste products and fluid can build up in your body. That can cause swelling in your ankles, nausea, weakness, poor sleep, and shortness of breath. Without treatment, the damage can get worse and your kidneys may eventually stop working. That’s serious, and it can be life-threatening.

So what exactly is the function of our Kidneys?

Healthy kidneys:

·        Maintain a balance of water and minerals (such as sodium, potassium, and phosphorus) in your blood

·        Remove waste from your blood after digestion, muscle activity, and exposure to chemicals or medications

·        Make renin, which your body uses to help manage your blood pressure

·        Make a chemical called erythropoietin, which prompts your body to make red blood cells

·        Make an active form of vitamin D, needed for bone health and other bodily functions

·        Filter all the blood in your body every 30 minutes

Types of Kidney Disease

• ·        Chronic kidney disease (CKD)

CKD is a condition where your kidneys cannot filter toxins or extra fluid from your blood as well as they should. While the condition can vary in how serious it is, CKD usually gets worse over time. Treatment, diet and lifestyle can slow the progression of the disease.

If left untreated, CKD may lead to kidney failure. At this stage, it is referred to as End-Stage-Renal-Disease (ESRD). This must be treated by dialysis or kidney transplant. Diabetes and high blood pressure are the leading causes of CKD.

But 40% of those with serious chronic kidney disease are unaware that they have the condition.

 

Other Common Forms Of Kidney Disease

• ·        Polycystic Kidney Disease

This genetic disorder causes cysts (fluid-filled sacs) to grow on your kidneys, limiting their ability to filter waste from your blood

• ·        Lupus Nephritis

Lupus is an autoimmune disease. Lupus nephritis is when your immune system attacks your kidneys

• ·        Interstitial Nephritis

This happens when you have a bad reaction to a medicine that limits your kidneys’ ability to filter toxins. If you stop the medicine, your kidney health should improve

• ·        Glomerulonephritis

This condition damages the glomeruli and your kidneys cannot function as well.

• ·        Long-lasting Viral iIlnesses

HIV and AIDS, hepatitis B, and hepatitis C may cause kidney disease.

• ·        Pyelonephritis

This is a urinary tract infection within the kidneys, which can result in scarring as the infection heals. It can lead to kidney damage if it happens several times.

 

Alcohol and Kidney Disease

Your kidneys are responsible for filtering harmful substances from your blood, including alcohol. When you drink, your kidneys have to work harder to perform their function.

Binge Drinking - which for women is having about four drinks in 2 hours, and for men five drinks in 2 hours can cause serious harm your kidneys. One risk of binge drinking is acute kidney failure, which is a sudden drop in kidney function that can damage the organs.

Regular heavy drinking can increase your chances of developing chronic kidney disease. Even two alcoholic drinks a day can increase your risk of high blood pressure, a common cause of kidney disease. Drinking alcohol can also disrupt hormones that help your kidney function.

Chronic Kidney Disease Causes

When your kidneys don't work well for longer than 3 months, doctors call it chronic kidney disease. You may not have any symptoms in the early stages, but that's when it’s simpler to treat.

Diabetes (types 1 and 2) and high blood pressure are the most common culprits. High blood sugar levels over time can harm your kidneys. And high blood pressure creates wear and tear on your blood vessels, including those that go to your kidneys.

 

Kidney Disease Symptoms

Your kidneys are very adaptable. They can compensate for some of the problems that can happen when you have kidney disease. So if your kidney damage gets worse slowly, your symptoms will reveal themselves slowly over time. In fact, you may not feel symptoms until your disease is advanced.

 

You might have:

• ·        High blood pressure
• ·        Nausea and vomiting
• ·        Loss of appetite
• ·        A metallic taste in your mouth
• ·        Fatigue
• ·        Weakness
• ·        Trouble thinking
• ·        Sleep issues
• ·        Muscle twitches and cramps
• ·        Swelling in your feet and ankles
• ·        Itching that won't go away
• ·        Chest pain if fluid builds up around the lining of the heart
• · Shortness of breath if fluid builds up in the lungs
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• How to Diagnose Kidney Disease
• ·        Blood tests to see how much waste product is in your blood
• ·        Urine tests to check for kidney failure
• ·        Imaging tests, like an ultrasound, to let the doctor see your kidneys
• ·        A kidney biopsy, where tissue from your kidney is sent to a lab for testing to figure out the cause of your kidney issues

 Kidney Disease Treatment

Some forms of kidney disease are treatable

The goals of these treatments are:

• ·        To ease symptoms
• ·        Help keep the disease from getting worse
• ·        Lessen complications

In some cases, your treatment may help restore some of your kidney function. But there is no cure for chronic kidney disease.

If a condition is “chronic,” that means it’s a long-term condition. If you have chronic kidney disease, you and your doctor will manage it together. The goal is to slow it down so that your kidneys can still do their job.

Steps in treating CKD

• ·        First, your doctor will work to find out what caused the kidney disease
• ·     For instance, kidney disease can happen if you have diabetes or high blood pressure.
• ·        You have to consult a nephrologist
• ·        You will take medication
• ·        Work on your diet
• ·        If you have diabetes, it needs to be managed
• ·        If your kidneys don’t work anymore, you might need dialysis or a kidney transplant

 

Ways to Keep Your Kidneys Healthy

• Don’t Overdo Certain Medications

NSAIDs are nonsteroidal anti-inflammatory drugs, like ibuprofen and naproxen. They can damage your kidneys if you take too many at once or take them too often. And using proton pump inhibitors (PPIs) for an ulcer or GERD for a long time can raise your chances of chronic kidney disease. You should only take them if your doctor says you need them.

• Take Care With Antibiotics

These bacteria-fighting drugs can damage your kidneys if you use them too often. It can happen even if you’re perfectly healthy, though it’s more serious if your kidneys don’t work as well as they should. Some types, like penicillin, sulfonamides, and cephalosporins, are more likely to cause problems.

• Skip Herbal Supplements

Supplement makers don’t have to prove their products are safe, and some can damage your kidneys. Those can be especially harmful if you have kidney disease because they can make the condition worse or affect how some medicines work. Talk with your doctor before trying any herbal supplement.

• Eat Healthy

Your kidneys process everything you eat or drink, including anything that’s bad for you, like lots of fat, salt, and sugar. Over time, a bad diet can lead to high blood pressure, obesity, diabetes, and other conditions that are hard on your kidneys. A healthy diet has lots of vegetables, fruits, and whole grains, and few processed foods.

• Watch Your Salt

This mineral affects people in different ways. For some, it seems to raise the amount of protein in their urine. That can harm your kidneys or make kidney disease worse if you already have it. Lots of salt also raises your chances of high blood pressure, a typical cause of kidney disease, and kidney stones, which can be very painful and possibly cause damage without treatment.

•  Drink Enough Water

Water helps get important nutrients to your kidneys and move waste to your bladder in the form of urine. If you don’t drink enough, the tiny filters inside your kidneys can get choked up and lead to kidney stones and infections. Even mild dehydration can damage your kidneys if it happens often enough. About 2 to 21/2 litres per day is typically about right, but you might need more if you are out in the heat.

• Exercise

Just like a healthy diet, this helps prevent conditions like diabetes and heart disease that can lead to kidney damage. But don’t try to go from couch potato to gym rat in a day. Too much exercise can also damage your kidneys if you’re not ready for it. Work your way up to 30 to 60 minutes at least five days a week. Start slow if you haven’t done it in a while, and check with your doctor first if you have health issues.

• Get Screened

It’s important to know your risk for kidney disease. It’s more likely if you or close relatives have heart disease, high blood pressure, diabetes, or a family history of kidney failure. In these cases, your doctor might suggest specific kidney tests as part of your regular check up. The earlier you catch it, the easier it is to treat and sometimes even stop.

• Be Careful With Alcohol

If you’re healthy, a drink or two isn’t likely to hurt your kidneys. But binge drinking (having more than four drinks in less than 2 hours) can cause sudden, serious damage and possibly lead to long-term problems. And alcohol often can dehydrate you, which can keep your kidneys from working well and lead to weight gain, liver disease, high blood pressure, and other conditions that put more stress on them.

• Quit Smoking

Smoking raises your risk of kidney cancer and damages blood vessels, which affects your kidneys by slowing blood flow to them. Plus, smoking can affect certain drugs that treat high blood pressure. This is serious because uncontrolled high blood pressure is a leading cause of kidney disease.

 

Are Plant Proteins Adequate?

 

Are Plant Proteins Adequate?

There is a misconception that vegetarians are always starved for proteins and have no option but to start eating non-vegetarian food or protein supplements to meet their daily protein requirement. The ideal protein intake for a healthy adult is around 0.8 to 1 gm per Kg body weight. Most of us do not reach this requirement; especially vegetarians. The reason being there is no conscious effort to balance our meals. Proteins add a satiety factor to our meals. Vegetarians, particularly, tend to eat extra carbs, and worse, eat fried foods and sweets, to complete their meals and feel satiated. It’s also a psychological feel-good way of making up for not eating non-vegetarian food, most of them admit.

Protein and Amino Acids

What you actually need from protein are the amino acids (building blocks of proteins). You need 20 different ones. Your body makes some of them, but you must get 9 from your diet. These are called essential amino acids.

Animal proteins are complete proteins. That means they contain all the (9) essential amino acids. Plant proteins are often, but not always, incomplete sources of protein, Examples of complete plant proteins are Quinoa, Buckwheat, Amaranth (Rajgira) and Soya.

 

There is a wide choice of protein foods for vegetarians:

• Soya and its products - Tofu, Edamame, Tempeh
• Seeds – Chia, Garden Cress (Aliv), Sesame, Sunflower, Pumpkin, Muskmelon and Watermelon
• The advantage of Garden Cress is its Low fat and high Protein content
• Different Nuts, Coconut, Foxnut (Makhana), Barley, Dals and Legumes, Dairy products
• Paneer (Cottage Cheese) – besides being a high protein food, it has good amount of calcium
• Curd - good source of easy to digest protein
• Millets – have high protein content and usable calcium
• Sattu (Roasted Bengal gram flour) – has 20 to 25 gm protein per 100 gm
• Quinoa, Amaranth, Teff and Buckwheat are complete proteins and also Gluten free
• Brewer’s yeast - Brewer's yeast is also a good source of protein. It contains approximately 16 g of protein per 30 g of powdered yeast
• Mushrooms - Vegetarian favourite when it comes to alternative sources of protein
• Baby corn – an advantage is that it has low fat and high protein content
• Moringa - rich in a large number of amino acids

 Lower Risk of Diseases

There are pros and cons to both plant and animal proteins. But diets that rely mostly on plants for protein have been linked to a lower risk of type 2 diabetes, stroke, heart disease, cancers and early death. 

Almost all plant-based protein sources are lower in fat and calories than animal protein. So naturally, swapping animal protein for plant-based protein will reduce your overall calorie intake. It also contains a lot of fibre, keeping you fuller for longer. In contrast, animal protein contains no fibre. Besides, plants are rich in antioxidants so essential for our overall well-being.

 Mix and Match

So although most plant proteins are incomplete, you can get all the essential amino acids you need from plant foods, as long as you eat a variety of them. The key is - Mix and Match

 

                 When Indigestion Is The Issue

Indigestion, upset stomach or dyspepsia - it is a group of digestive symptoms that usually happen at the same time such as:

• pain, a burning feeling or discomfort in your upper belly
• feeling full too soon while eating
• feeling uncomfortable

Occasional indigestion is normal, but sometimes it happens regularly for a few weeks or months. This could be a sign of an underlying problem like gastroesophageal reflux disease (GERD), ulcers, or gallbladder disease.

Symptoms

·       Burning or pain in the upper belly
·       Feeling full too soon or for too long after eating
·       Bloating
·       Burping and gas
·       Nausea and regurgitation (when the food you swallow comes back up into your esophagus)
·       Vomiting
·       Acid reflux and heartburn
·       Loud growling or gurgling in your stomach
·      Burping

Constipation

Indigestion and constipation often go together. Many people who have gastroesophageal reflux disease (GERD) will also have constipation. Getting relief for your indigestion may also help your constipation.

 Causes

• Occasional indigestion is usually caused by eating a large or fatty meal.
• Indigestion that lasts longer than one meal or that comes and goes may be caused by your lifestyle, a medical condition, or a medicine you take regularly 
• Sometimes, people have persistent indigestion that's not related to any of these facts

Lifestyle factors

·       Eating too much, eating too fast, or eating during stressful situations
·       Eating foods that your body has a hard time digesting (food intolerance)
·       Smoking or using other tobacco products

 Common Food Triggers for Acid Reflux - a cause of indigestion

·       Fatty and fried food
·       Spicy foods

·       Foods with a lot of acid, like citrus fruit, tomatoes, tomato sauces and vinegar

·       Alcohol
·       Fizzy drinks
·       Caffeine
·       Chocolate
·       Onions
·       Peppermint

If you eat any of these regularly, stop eating them for a while to see how you do. Add them back in one by one to see if any trigger your indigestion.

 Some medical conditions that may cause indigestion 

·       Irritable bowel syndrome (IBS)
·       Ulcers
·       Gastroesophageal reflux disease (GERD)
·       Too much stomach acid (hyperchlorhydria)
·       Slow stomach emptying (gastroparesis)
·       Swelling in your stomach lining (gastritis)
·       Hiatal hernia
·       Bacterial stomach infections
·       Eating disorders, such as anorexia nervosa and bulimia
·       Gallstones and gallbladder swelling
·       Chronic pancreatitis
·       Autoimmune conditions, such as thyroid disease or celiac disease
·       Pregnancy
·       Stomach cancer (very rare)

 Treatment

This usually depends on the cause

• Making changes in how and what you eat and drink, such as avoiding foods that cause indigestion
• Trying psychological therapies to help manage any anxiety, depression, or stress that may cause your indigestion
•  Taking over-the-counter or prescription medicine for indigestion or acid reflux, such as antacids or antibiotics

Usually, you might not need any treatment. Indigestion often goes away on its own after a few hours. But see a doctor if your symptoms get worse.

Home Remedies Worth Trying

·       Chamomile tea
·       Licorice root
·       Fennel tea

• Cumin and hing tea

·       Ginger tea or add a bit of fresh ginger root to rice or oatmeal
·    1 to 2 tsp. Raw Apple cider vinegar in a cup of warm water sipped slowly before meals
·       Aloe Vera juice
·       Banana
·       Kokum

 

Unhealthy Habits to avoid after a meal

·   Do not drink tea. Tea leaves contain high acid content that will harden protein in your food making it difficult to digest.

·       Do not bathe. It will increase blood flow to hands and legs and slow down digestion of food

·       Do not walk around. It can result in indigestion. However, walking about half an hour after meals is known to be good for you.

·       Do not sleep immediately.  The food will not get digested

Role of Fermented foods in digestion

·   Idli – starches in dal and rice are broken down by the fermentation process so that they are more readily digested by the body
·     Lassi and curd - reduces acidity in the stomach, promotes digestion. Also probiotic
·      Soy sauce - can help support the growth of good bacteria in our large intestine
· Miso – has Lactobacillus acidophilus which may be useful in conditions like lactose intolerance or overgrowth of bacteria in intestines 
·  Fermented cucumbers and radish – has lactobacilli which enhances digestibility and also encourages growth of useful bacteria in our large intestine