The silent actors in the drama of kidney disease- Smoking and alcohol

Chronic kidney disease (CKD) is a growing worldwide problem that is increasingly shown to be interwoven with cardiovascular disease (CVD), smoking and excessive alcohol consumption. In addition, because of the kidneys’ important and varied role in the body, impairment of their function can result in a range of disorders, from mild differences in fluid balance to acute kidney failure and death. Alcohol, one of the numerous factors that can damage and reduce kidney function, can interfere with kidney function directly, through short term excess or long term consumption, or indirectly, as a consequence of liver disease.

Alcohol when taken in excess has many negative effects on the body. From impacts on brain function where it leads to confusion and risk for accidents and dementia, to liver disease and cancer. Alcohol can also have negative effects on kidney function.

The benefits of smoking or alcohol consumption are very difficult to identify and are at best minimal and of no real tangible benefit to its users. However, the harmful effects of these common social pleasures are well documented but not commonly known.

This post is aimed at educating readers on the harms of these silent actors to a common and growing problem of kidney disease and kidney failure. In summary, there is no safe amount of cigarette smoke to be exposed to. There are levels of alcohol intake above which health problems occur including kidney disease.

Alcohol and the kidney

Drinking alcohol can affect many parts of your body, including your kidneys. A little alcohol—one or two drinks now and then—usually has no serious effects because the body can easily and quickly get rid of the alcohol from the body. But drinking too much even if you do not have a damaged liver can harm your health and worsen or accelerate kidney disease.

For instance, alcoholics with damaged livers have been shown to have enlarged kidneys  with reduced blood flow to the kidneys. Alcohol can have effects on the kidney even in people without damaged livers by causing loss of water (remember the frequent urination?) as well as nutrients in the body such as magnesium, phosphate, calcium, sodium and potassium all of which have important functions in the body. Alcohol taken in large quantities over months to years can also impair the ability to control blood pressure through mechanisms that are yet to be fully understood and has a negative impact on the ability of the kidney to control acid balance.

How much alcohol is too much?

When experts talk about one drink, they are talking about one 350 ml bottle of beer, one glass of wine (150 ml), or one shot (45 ml) of “hard liquor.” Hard liquor includes vodka, brandy, whisky and other spirits.

Having more than three drinks in a day (or more than seven per week) for women, and more than four drinks in a day (or more than 14 per week) for men, is considered “heavy” drinking. The kidneys of heavy drinkers have to work harder. Heavy drinking on a regular basis has been found to double the risk for kidney disease and kidney failure requiring dialysis and kidney transplantation.

Binge drinking (usually more than four to five drinks within two hours) can raise a person’s blood alcohol to dangerous levels. This can cause a sudden drop in kidney function known as “acute kidney injury.” When this happens, dialysis is needed until a person’s kidney function returns to normal. Acute kidney injury usually goes away in time, but in some cases, it can lead to lasting permanent kidney damage.

Some people should not drink at all. Ask your healthcare provider if it is safe for you to drink, especially if you have a medical condition or take medicines that might be affected by using alcohol. Women, older people, and those with smaller bodies should be especially careful. Of course, pregnant women are advised not to drink alcohol.

For more information on the use of alcohol in Nigeria and the harmful effects including the impact on liver disease and road traffic accidents, read a world health organization report by clicking here.

Smoking and the kidney.

One of the many things that contribute to the poor understanding of the harmful effects of cigarette smoking is a lack of knowledge of what is contained in a cigarette. There are few effective labels or warnings about the dangers or harms of smoking.

There are no known health benefits of cigarette smoking

Nicotine is the principal substance contained in cigarettes that not only has impact on brain function but has addiction potential. There are approximately 600 ingredients in cigarettes. When burned, they create more than 7,000 chemicals. At least 69 of these chemicals are known to cause cancer, and many are poisonous or can damage the kidney.

Many of these chemicals are also found in consumer products, but these products have warning labels. While the public is warned about the danger of the poisons in these products, there is no such warning for the toxins in tobacco smoke.

Here are a few of the chemicals in tobacco smoke, and other places they are found:

• Acetone – found in nail polish remover
• Acetic Acid –  an ingredient in hair dye
• Ammonia – a common household cleaner
• Arsenic – used in rat poison
• Benzene – found in rubber cement
• Butane – used in lighter fluid
• Cadmium – active component in battery acid
• Carbon Monoxide – released in car exhaust fumes
• Formaldehyde – embalming fluid
• Hexamine – found in barbecue lighter fluid
• Lead – used in batteries
• Naphthalene – an ingredient in moth balls
• Methanol – a main component in rocket fuel
• Nicotine – used as insecticide
• Tar – material for paving roads
• Toluene – used to manufacture paint

 

Can smoking cigarettes affect my kidneys?

Yes, for the following reasons:

• Smoking can interfere with medicines used to treat high blood pressure. Uncontrolled or poorly controlled high blood pressure is a leading cause of kidney disease.
• Substances released from inhaling cigarette smoke can damage blood vessels and eventually slows the blood flow to vital organs like the kidneys and can worsen already existing kidney disease.

E-cigarettes?

E-cigarettes have not been fully studied, so consumers currently don’t know:

• the potential risks of e-cigarettes when used as intended,
• how much nicotine or other potentially harmful chemicals are being inhaled during use, or
• whether there are any benefits associated with using these products.

Additionally, it is not known whether e-cigarettes may lead young people to try other tobacco products, including conventional cigarettes, which are known to cause disease and lead to premature death.

 

What health problems are related to smoking?

According to the World Health Organization, smokers have an increased risk of developing:

• Lung cancer
• Bladder cancer
• Lung disease
• Mouth cancer
• Heart disease
• Pancreas cancer
• High blood pressure
• Cervical cancer
• Stroke
• Pregnancy complications
• Kidney cancer
• Early menopause

For more information on the impact of tobacco use on health, read the world health organization fact sheet on tobacco use by clicking here.

 

Food and the patient with Kidney disease or Kidney failure

Kidney function is essential for removing the waste material and some toxins from food that you eat. The kidneys excrete a dietary protein called urea, as well as excess amounts of sodium, potassium, and phosphate. These substances can build up in the body if kidney function is impaired and cause harm.

Following a strict diet can lessen the excessive accumulation of these substances and their bad effects on the body.

A kidney diet has to be balanced and take into account the stage of the patients disease. Taking too much fluid, salt or potassium may be very harmful. Read below for more details.

 

Controlling your phosphorus (Phosphate)

Excess phosphorus is a mineral that healthy kidneys get rid of in the urine. In kidneys that are failing, phosphorus builds up in the blood and may cause many problems including muscle aches and pains, brittle, easily broken bones, calcification of the heart, skin, joints, and blood vessels. To keep your phosphorus levels in check, consider the following tips:

    1. Intake of foods low in phosphorus

•      Grape
•      Vegetables: cabbage, green beans, spinach, lettuce, carrot, cucumber, pear, plum, Pineapple, apple, mango, white bread, pasta, watermelon, potatoes

2. Moderate intake of high phosphorus foods such as:

• Meats, poultry, dairy and fish
• Milk and other dairy products like cheese

3. Avoid high phosphorus foods such as:

• Black Beans, Red Beans, Black-eyed Peas, White Beans, and Garbanzo Beans, nuts
• Dark, whole or unrefined grains, whole wheat, Rice, corn
• Cheese (low fat cheese), Wara (yoruba)
• Low fat yoghurt
• Dried vegetables and fruits, Garlic
• Chocolate, peanut butter,

4. Don’t forget to take your phosphate binders with meals and snacks.

• Your doctor may or may not prescribe a medication called a phosphate binder. You need to take your phosphate binder as prescribed by your doctor. Often you will take a phosphate binder with every meal and snack you take. This reduces the amount of phosphate you absorb from food while allowing you to absorb other important nutrients. Phosphate binders do not prevent absorption of all phosphate.

Controlling your Potassium

Potassium is an element that is necessary for the body to keep a normal electrical activity and water balance between the cells and body fluids. All foods contain some potassium, but some contain larger amounts.

Normal kidney function will remove potassium through urination. Kidneys that are not functioning properly cannot remove the potassium in the urine, so it builds up in the blood. This can be very dangerous to your heart. High potassium can cause irregular heart beats and can even cause the heart to stop if the potassium levels get to high.

Typically, there are no symptoms for someone with a high potassium level. If you are concerned about your potassium level, check with your doctor, and follow the tips below.

• The following foods are high in potassium and intake of these foods should be limited:

Bananas, Avocado, Oranges, Orange Juice, Prunes, Prune Juice, Tomatoes, Tomato Juice, Tomato Sauce, Tomato Puree, Melon, Nuts, Pawpaw, Chocolate, Red Beans, Milk White Beans, cabbage, onions, groundnut, walnut, mushrooms, corn, potatoes

• Dark leafy vegetables e.g tete, soko,ugu, green, okro,

Potatoes and vegetables can also contain a lot of potassium but can be specially prepared to reduce the amount of potassium contained in them. For potatoes, 

1. Peel and slice into 1/8 inch pieces.

2. Soak 1 cup potatoes in 5 cups of water for 2 hours.

3. Drain and rinse and drain.

4. Cook in a large amount of water.

5. Drain and mash, fry or serve plain.

For vegetables,

1. Slice and wash in plenty water,

2. Drain the water

3. Cook in plenty water

4. Drain the water

5. Use vegetables to cook food or cook vegetables with other ingredients

Foods Low in Potassium

White bread

White rice

Eggs

Apples ( limited amount)

 

Controlling your sodium (salt)

Sodium, or sodium chloride is an element that is used by all living creatures to regulate the water content in the body. Usually a sodium restriction comes in the form of “No Added Salt.” This is necessary because a greater intake of sodium will result in poorly controlled blood pressure and excessive thirst which can lead to difficulty adhering to the fluid restrictions in your diet. However, your doctor can allow you a limited amount of sodium which can vary between 2-6gms per day

To limit your sodium, you should:

• Avoid table salt and any seasonings that end with the word “salt”

 

• Avoid salt substitutes (they contain potassium)
• Avoid salty meats such as bacon, ham, sausage, hot dogs, lunch meats, canned meats
• Avoid salty snacks such as cheese curls, salted crackers, nuts, and chips
• Avoid canned soups, frozen dinners, and instant noodles
• Avoid bottled sauces, pickles, olives, and MSG

. Salted Butter, milk, carrot, spinach, legumes

 

Foods Low in Sodium

Sugar

Onion, ginger garlic, mushrooms

Pasta, Rice, Macaroni

Tomatoes, plum,

Fresh fruits and vegetables except those listed above

 

Cooking Instructions for low sodium.

1. Cook meat / poultry / fish with recommended allowance of sodium

2. Then use the stock to cook soup / food

 

Controlling your protein

Protein is important to aid in growth and maintenance of body tissue. Protein also plays a

role in fighting infection, healing of wounds, and provides a source of energy to the body.

• For patients with advanced kidney disease not yet on dialysis, it is important that you take some protein but do not take too much. Remember, you need protein for all of the functions above. The reason for asking patients to reduce their protein intake when they have significant disease but are not yet on dialysis is that an excessive protein load can accelerate the path to kidney failure. However note that many other aspects of care are likely more important than protein intake to reduce the progression of kidney disease such as control of blood sugar, control of blood pressure and relief of any obstruction.                                                                                   
• For patients with kidney failure, there is absolutely no need to restrict protein as the kidneys have failed and protein restriction will not restore kidney function that has been lost. 
• You should make sure to eat one tenth of a kilogram of protein every day.
• Foods that are high in protein include beef, pork, veal, chicken, turkey, fish, seafood, and eggs.
• 1 average sized egg for example is equal to one-twentieth of a kilogram of protein.

   

  How to be successful on a renal diet

  Moderation

  Dietary Guidelines emphasizes the importance of eating a variety of foods. This applies to dialysis patients, too. You can enjoy all foods in moderation while following a renal diet. One of the guidelines states:

  “Be sensible: Enjoy all foods, just don’t overdo it.”

  We Encourage You To:

  • Slow down while eating. Avoid anxiety and worry at meal times. It takes 20 minutes to send the signal that you’ve had enough to eat.

  . Put down fork between bites

  . Do not put bowls of food on the table

  • Stop eating when full. Patients should walk away from the table feeling that they can eat a little more.

  . Leave the table as soon as eating is done

  • Have one small helping of that chocolate cake once in a while and enjoy every bite.
  • Enjoy that piece of sphagetti twice as much. Eat half in the restaurant and take the rest home to enjoy the next day.

  The Goal

  The goal for our patients should be to achieve optimal nutritional status, a healthy lifestyle, that can be maintained rather than a short-term diet that will most likely be abandoned and produce psychological discomfort and metabolic imbalance.