Obesity Fuels Chronic Kidney Diseases

A health survey conducted by the Dubai Health Authority in collaboration with the Dubai Statistics Centre revealed that 11.9% of people in Dubai suffer from obesity.[i] The growing issue of obesity plays a key role in reducing people’s life expectancy and causes several severe health conditions. Obesity is a combination of factors including high calorie intake, lack of exercise, sedentary lifestyle practices etc. Obesity is now a growing phenomenon across the globe and is one of the key factors responsible for a number of chronic diseases including kidney diseases.

Obesity causes mortality due to diabetes, stroke, conditions of the heart, certain cancers etc. However, a rarely discussed and rather unknown fact is the link between obesity and its consequences on the kidney. Obesity is directly linked to chronic kidney diseases (CKD) and its progression because obesity facilitates diabetes and hypertension which are the two common causes of kidney conditions. Body Mass Index (BMI) is the most used parameter to determine obesity, however, the waist circumference or waist to hip ratio is a better indicator of chronic health conditions. Obesity influences chronic kidney conditions in two ways; an obese individual is at a higher risk of diabetes and high BP which are causative factors of CKD. On the other hand, an obese individual’s kidneys will have to function much harder for the process of filtration in order to meet the demands of a person with higher BMI. An obese individual can also be at the risk of having kidney failure.

Obesity is reported to be one of the leading causes for chronic kidney conditions and end-stage renal disease (ESRD). The end stage of chronic kidney conditions is called ESRD when they kidneys are no longer able to function to its ability on a daily basis.

The most common kidney damaging conditions are;

Polycystic kidneys: is a condition where a person has multiple cysts in the kidneys causing it to enlarge. This condition is generally a birth defect.

Kidney stones: or Nephrolithiasis are hard mineral deposits made of acid salts that form inside the kidney or urinary tract. People who take medicines for gout are at a risk of kidney stones, dehydration is also a cause for the condition.

Proteinuria: a condition developed when there is abnormal protein in the urine. Albumin is a protein found in the human blood because the body needs it to fight infections, build muscle etc. The function of the human kidney is to filter the blood and remove things that aren’t required by the body. There will be an underlying cause for proteinuria which needs evaluation.

Focal segmental glomerulosclerosis: is a condition caused by scarring of the kidney. This condition may be caused due to primary or secondary reasons. The primary reason of scarring being no obvious cause, the secondary reason may be caused by another pre-existing condition, a prescribed drug, obesity or any other underlying condition.

Glomerulonephritis: is a condition causing inflammation of the Glomeruli (the kidney cell). This can lead to Hypertension, blood in the urine and proteinuria. In certain cases, this can progress to acute kidney failure.

It is extremely important to keep your kidney healthy for it to function to its full capability. Your blood sugar needs to be in control, failing which will cause diabetes. Keeping your body and mind fit by staying active helps in keeping the body fit and healthy. Water is key to prevent kidney conditions, drinking water flushes out the toxins from the kidneys and reduces the chance of kidney stones. Smoking is a causative factor for a number of health conditions, and it is always best to quit it. Certain over the counter medications may also cause kidney damage. This does not mean that they should not be taken at all, however, a physician must be consulted before self-medication. Routine medical checks are important to screen for chronic kidney conditions and for those who aren’t aware of the health risks they have. An obese individual must be aware of the positive impacts of losing weight which will include prevention and reduction of various chronic health conditions like diabetes, hypertension, heart diseases and kidney conditions.

Every year, March 9th is celebrated as World Kidney Day with the aim of educating people about the importance of kidney health and the diseases associated with the kidney. This year World Kidney Day goes by the theme of ‘kidney disease and obesity’ because obesity is a potential risk factor for kidney diseases which is an unknown fact. Obesity and chronic kidney conditions are both preventable, upon undertaking healthy lifestyle practices. This kidney day lets us all promise ourselves to ensure adopting and advocating healthy lifestyle practices to beat the harmful health consequences of obesity and related kidney diseases.

Dr. John Cherian Varghese

Specialist Nephrologist 

Aster Clinic & Hospital 

Dr. John Cherian

[i] –  http://gulfnews.com/news/uae/health/survey-12-of-dubai-population-is-obese-1.1838295

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GERD – Symptoms and Prevention

GERD is a condition in which the stomach acid or contents from the stomach flow back into the food pipe (esophagus). The backwash (reflux) irritates the lining of the esophagus and causes GERD. Gastroesophageal refers to the stomach and the esophagus. While reflux refers to the back-flow of acidic or non-acidic stomach contents into the esophagus. A band of muscles at the junction of the stomach and esophagus called the lower esophageal sphincter (LES) normally act, in conjunction with the diaphragm, as a barrier to prevent the reflux of stomach contents into the esophagus. It is when that barrier is relaxed at inappropriate times or is otherwise compromised that reflux occurs.

GERD is characterized by symptoms and/or tissue damage that results from repeated or prolonged exposure of the lining of the esophagus to contents from the stomach. If tissue damage is present, the individual is said to have esophagitis or erosive GERD. The presence of symptoms with no evident tissue damage is referred to as non-erosive GERD.

GERD symptoms are often persistent, such as chronic heartburn and the regurgitation of acid. But sometimes there are no apparent symptoms, and the presence of GERD is revealed only when complications become evident. While the symptoms of GERD vary from person to person, the majority of people with GERD have mild symptoms, with no visible evidence of tissue damage and little risk of developing complications.

Periodic heartburn is a symptom that many people experience. If it occurs occasionally just after a meal and less than once per week, it is likely a “benign” condition. However heartburn that occurs more frequently than once a week, becomes more severe, or occurs at night and wakes a person from sleep, may be a sign of a more serious condition and consultation with a physician is advised. Even occasional heartburn – if it has occurred for a period of 5 years or more, or is associated with difficulty in swallowing– may signal a more serious condition. People with long standing chronic heartburn are at greater risk for complications including stricture or a potentially pre-cancerous disease that involves a cellular change in the esophagus called Barrett’s esophagus.

Persistent chronic heartburn and acid regurgitation are the most common symptom of GERD. But there are numerous less common symptoms that also may be associated with GERD. These may include:

  • Belching
  • Difficulty or pain when swallowing
  • Water brash (sudden excess of saliva)
  • Dysphagia (the sensation of food sticking in the esophagus)
  • Chronic sore throat
  • Laryngitis
  • Inflammation of the gums
  • Erosion of the enamel of the teeth
  • Chronic irritation in the throat
  • Hoarseness in the morning
  • A sour taste
  • Bad breath

Chest pain may also indicate acid reflux. Nevertheless, this kind of pain or discomfort should prompt urgent medical evaluation in order to exclude possible heart conditions. Relief of symptoms after a two-week trial therapy with a proton pump inhibitor (a prescription medication that inhibits gastric acid secretion) is an indication that GERD is the cause. This can also be confirmed with pH monitoring, which measures the level of acid refluxing into the esophagus and as high as the larynx.

On the positive side, since GERD is a lifestyle disorder, making significant changes in your lifestyle and eating habits can greatly reduce the impact of GERD or even prevent its onset to begin with. Here are 10 tips you can try to prevent GERD.

  1. Lose weight. Obesity is the leading cause of GERD because the extra stomach fat places pressure on your abdomen, pushing gastric juices up into your esophagus.
  2. Avoid foods known to cause reflux.If you’re at risk for GERD, avoid:
    • Fatty foods
    • Spicy foods
    • Acidic foods, like tomatoes and citrus
    • Mint
    • Chocolate
    • Onions
    • Coffee or any caffeinated beverage
    • Carbonated beverages
  3. Eat smaller meals.Large meals fill the stomach and put pressure on the LES, making reflux and GERD more likely.
  4. Don’t lie down after eating.Wait at least three hours before you lie down after a meal. Gravity normally helps keep acid reflux from developing. When you eat a meal and then stretch out for a nap, you’re taking gravity out of the equation. As a result, acid more easily presses against the LES and flows into the esophagus.
  5. Elevate your bed.Raising the head of your bed six to eight inches can help gravity keep gastric acid down in your stomach. You could also use a wedge-shaped support. Don’t use extra pillows, as they only raise your head and will not help with GERD. You need your entire upper body elevated to get relief.
  6. Review your medications.There are a number of medications that can increase your risk of GERD, either by relaxing the LES, interfering with the digestive process, or further irritating an already inflamed esophagus. These medications include:
    • Non-steroidal anti-inflammatory drugs, or NSAIDs
    • Calcium channel blockers (often used to treat high blood pressure)
    • Certain asthma medications, including beta-agonists like albuterol
    • Anticholinergics, medications used to treat conditions such as seasonal allergies and glaucoma
    • Bisphosphonates, used to boost bone density
    • Sedatives and painkillers
    • Some antibiotics
    • Potassium
    • Iron tablets

If you are taking any of these medications, talk to your doctor about switching to another drug that does not have the same effect on the upper digestive tract. However, never stop taking a prescribed medication without first consulting your doctor.

  1. Quit smoking.Some studies have found that nicotine can relax the muscles of the LES and can also interfere with your saliva’s ability to clear acid out of the esophagus.
  2. Cut back on alcohol.As with smoking, alcohol can cause the LES to relax. Alcohol can also cause the esophageal muscles to spasm.
  3. Wear loose-fitting clothes.Do not wear tight clothing or belts that can constrict your stomach.

In the UAE itself, there has been a rise in the incidents of patients suffering from some degree of GERD. Specialists at Aster Hospital and Clinic often receive 2 to 3 patients a day with GERD. In the last 1.8 years, they have treated around 320 patients with the condition. Aster Hospital and Clinic has initiated a “GERD Awareness Campaign” to educate the residents of UAE on alarming symptoms or critical symptoms associated with the disease which, if noted, should prompt medical attention. Through dedicated programmes for the general population, Aster aims to encourage early diagnosis and proper treatment in order to improve the quality of life of people suffering from the condition.

 

Dr. Sabu Antony

Specialist Gastroenterologist

Aster Clinic, Bur Dubai (AJMC)

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Obesity and GERD, a heavy load indeed

As per WHO reports, at least 2.8 million people die every year from being overweight or obese. According to revelations of a health study, more than 35% men and over 30% women in Dubai are overweight with a total 12% being obese. Obesity is on the rise in the UAE and also globally, studies report that the rate of obesity in UAE is double the world average.

This is a rather substantial issue in the UAE that only seems to be getting worse. Many point to the lifestyles in UAE as a major contributor of this health condition. Easily accessible fast foods, long working hours, lack of any physical activity etc. are leading contributors to the rising numbers. BMI or body mass index is the measure of obesity that is calculated using a person’s height and weight. A BMI of 20-25 is considered healthy, BMI greater than 25 is considered overweight and greater than 30 is considered obese. An obese individual may be more prone to major health issues like conditions of the heart, breathing problems, diabetes, knee and joint pains, difficulty in walking, GERD etc.

Studies now reflect that being even slightly overweight can increase the risk and severity of Gastro Esophageal Reflux Disease or GERD. This is reiterated by a study published in the New England Journal of Medicine, which states that relatively small changes in weight, even in a normal weight person can increase the severity of acid reflux and the symptoms associated with it. The study outlines a direct relation between the body mass index and GERD. The more the BMI, the more chances of a person to experience heartburn. The study also established that overweight individuals are twice as likely to develop GERD as compared to people with normal body weight and obese individuals are three times more likely to develop the condition.

GERD is a chronic condition in which contents of the stomach flow back into the esophagus resulting in symptoms such as heartburn, chest pain, bad breath, acidic taste in the mouth, breathing problems etc. Exposure of the esophagus to acid reflux for prolonged periods may also have long-term consequences like inflammation of the esophagus, narrowing or tightening of the esophagus causing difficulty in swallowing or Barrett’s esophagus. Obesity contributes to GERD in several ways. Simplest mechanism is probably by increasing intra-abdominal pressure, but there are perhaps hormonal mechanisms also that play a part. Choice of food is also important. Fatty foods tend to stay in stomach longer and have a higher probability to contribute to reflux.  Avoiding fatty, acidic or spicy foods can help reduce symptoms to quite an extent. Exercise helps in many ways too.

When it comes to weighing treatment options, the most frequently asked question is what needs to be treated first, obesity or GERD. It is probably wise to tackle both simultaneously.

In the case of obese people who have multiple risks to their health, bariatric surgery can help loose excess amount of body weight and reduce associated morbidity. Surgery is an option that should be considered only after trying to reduce weight through traditional means first and if there is a very obvious threat to health and wellbeing of the patient.

It is crucial for people to understand the various means of treatment for both obesity and GERD and its consequences.

Obesity is the root cause for a number of health conditions and GERD is one of them. Treating obesity requires a multipronged approach involving several health professionals and disciplines.

——–

Dr Amal Upadhyay

Consultant Gastroenterologist

Aster Hospital Mankhool

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