Binge-eating to cope with stress coupled with inactivity may result in diabetes and ultimately, kidney disease, writes Meera Murugesan.
WHEN Lisa (not her real name) was younger, she didn't give much thought to her diet. She enjoyed eating and loved going to new restaurants with her friends.
At home, she constantly snacked while watching TV. Her weight wasn't ideal. On top of that, she didn't exercise.
Today, Lisa is one of the 40,000 dialysis patients in Malaysia and sadly, many more will join her.
One in five adults, or about 3.9 million people aged 18 and above in Malaysia, suffer from diabetes, according to the recently-released National Health and Morbidity Survey (NHMS 2019).
Diabetes is a key risk factor for kidney disease. The diabetes prevalence in Malaysia is 18.3 per cent now, compared to 13.4 per cent in 2015.
According to the nationwide survey, 49 per cent of diabetics in the country have never been screened or diagnosed with the disease.
Inactivity is also on the rise. NHMS 2019 shows that one in four adults aged 16 and above in Malaysia is not physically active, and about 50 per cent of adults are overweight, all risk factors for diabetes and kidney disease.
This trend could worsen given the current pandemic as more people turn to binge-eating to cope with anxiety over finances, job instability and personal health.
Exercise or physical activity rates are also low as more individuals stay home over fears of Covid-19.
The World Health Organisation (WHO) has predicted that Asia will have the highest number of diabetics by 2030.
Chronic kidney disease (CKD) is often associated with diabetes. The most common causes of CKD point back to how we lead our lives.
"Diabetes will harm the blood vessels, causing multiple organ damage to the heart, kidneys, brain and eyes," says Mahkota Medical Centre internal medicine and nephrology specialist Dr Yew Shiong Shiong.
There are many small blood vessels known as glomeruli in the kidneys. These function as filters of waste products for the body, he explains.
Diabetes is a disease of abnormal high sugars in the body and the glomeruli will become damaged if blood sugars are not controlled.
Left unchecked for too long, they can proceed to progressive and irreversible damage to kidney function, resulting in end stage renal failure where patient needs lifelong therapy like dialysis or a kidney transplant.
Chronic kidney disease can be totally asymptomatic – only detectable as protein in the urine if you do a urine test.
But as it progresses, patients may experience swelling, lethargy, pallor and shortness of breath. In the very critical and late stages, patients may have seizures and persistent vomiting.
Most don't even realise that their kidneys are failing.
"In poorly controlled cases, it takes an average of three to five years from the onset of diabetes to result in diabetic kidney diseases. Up to one third of diabetic patients are at risk of kidney damage," says Dr Yew.
The damage is usually reversible if the duration is less than three months. However, as diabetes is a persistent disease and may be poorly controlled in some patients for months or years, the damage would usually be non-reversible.
The disease doesn't just affect the individual; public spending on CKD is on an increase as well.
In 2016, that figure was RM1.12 billion (according to the Economic Burden of End-Stage Renal Disease to the Malaysian Healthcare System), which is 25 times higher than the overall average health spending per person.
It is estimated that this year, public spending will increase to RM2 billion and RM4 billion by 2040.
TAKE CHARGE OF YOUR HEALTH
Ultimately, you are in charge of your health and CKD is not something you should leave to chance, says Dr Yew.
Prevention is better than cure so stay active, exercise, eat less sugary foods and less carbohydrates, especially if you are diabetic.
If you are already a kidney patient, you need to watch your salt and protein intake according to the stage of damage.
"For really late stage patients, they need to limit potassium and phosphate," advises Dr Yew.
He adds that if you are at risk of CKD, not only do you need to maintain a healthy and balanced diet and lifestyle, you need to have proper health follow-up as your doctor will need to consistently monitor the disease to avoid unexpected deterioration of your health.
"You can't always prevent CKD, especially if your genes have something to do with it. However, making lifestyle changes cannot be emphasised enough and these can help slow the progression of kidney disease. It could even save your life."
Source: New Straits Times