The kidneys and the kidney meridian

Fiona Hardie explains that there is a direct link between the kidneys and their associated kidney meridian hence reflexology can have a healing impact on the kidneys.


Did you know that the season that the kidneys are related to and during which their energy is most active is winter. And spring is that time of the year when we should be energised and have, well, a spring in our step. While winter may well be behind us, taking care of our kidney health all-year-round ensures decreased vulnerability to colds and flu, as well as an easy transition to spring without hay fever or the inevitable summer cold that often ensues.

When looking at any organ in the body, there are two perspectives that must be referenced. The Western perspective is one we are all mostly familiar with. Yet the Traditional Chinese perspective has a very different, yet effective approach from which reflexology draws a lot of inspiration .

Western perspective

From the Western perspective, the kidneys are involved in filtering toxins from the body and having them expelled through the urine.  The functions of the kidneys are remarkable:

  • These organs are tasked with recognising and separating waste materials from useful substances and determining how much of that specific substance the body needs.
  • Excess hormones, vitamins, minerals and any foreign matter, such as additives from food or drugs, are sorted and sent for elimination by the bladder.
  • Our electrolyte balance is maintained ensuring that sodium, potassium, hydrogen, magnesium, calcium and other mineral levels are in check.
  • Vitamin D is converted into a usable state while the acid-alkaline balance of the body is also modulated.
  • Not only mineral levels, but the body’s overall fluid requirements are constantly being monitored by these two bean-shaped organs.
  • Red blood cell production is stimulated by a hormone, called erythropoietin, which is produced by the kidneys.
  • On top of all that, the kidneys also have a double filtration system to filter the blood.

Traditional Chinese perspective

Looking at the above, it’s an impressive list of tasks that the kidneys perform and is clear to see why in Chinese medicine the kidneys are considered the storehouses of our “essence.” Essence is that life force which keeps us healthy, vital and youthful.

As a result, the Chinese associate weak kidney energy with premature ageing, early greying of hair, balding, loss of libido, impotence, irregular menstruation and poor willpower to name but a few symptoms of having a sluggish internal system.

Kidney meridian

Let’s face it, if our blood is stagnant and toxic, how can our organs have the energy to perform their duties? How can we have the energy to enjoy our life or produce life?

The kidneys also rule the teeth, bones and produce marrow. A close relationship exists between the kidney and the ears as is evidenced when we get a cold and our ears become blocked or infected.

The kidneys almost always feel tender when a respiratory infection is setting in. We get that achy feeling in our lower backs. In fact, many back problems are often associated with a congested kidney meridian or its partner the bladder meridian which runs up along the spine.

This brings me to kidney meridian congestions and how they present in the body from a reflexology perspective. Burning, sweating and painful soles and fungal infections are often signs of a kidney imbalance. Weak ankles, puffiness and swelling of the foot are indications of weaknesses in the kidneys and bladder. The kidney meridian runs along the inner aspect of the calf and thigh, and pains, varicose veins, knee problems in these areas often point to imbalances in these organs.

The kidney meridian then continues through the diaphragm, and the lungs and of course any lung congestions, diaphragmatic dysfunctions and breast disorders will be considered symptoms of weaknesses here.

Traditional Chinese medicine also associates emotions with the organs and where the kidneys are concerned fear and anxiety are the related emotions. Hence panic attacks, phobias, and constant anxiety are related to the kidneys. When we work on healing these emotions, the kidneys will also heal, and vice versa.

In summary

There is a direct link between the kidneys and their associated kidney meridian. Therefore with the direct focus on the meridians for which reflexology is known, it becomes clear that reflexology can have a direct impact on the kidneys.

With knowledge of kidney imbalances above, it is quite useful to know about the incredible healing effects of reflexology, as it can have a direct and immediate impact. The sense of relaxation brought about by reflexology will also assist in reducing anxiety and fear and coax the body holistically to heal.

Reflexology is best enjoyed over a series of eight to 10 treatments during which time the congestions in the meridians and their organs are cleared, bringing the body to a state of balance. And it is when in balanced harmony that the body is able to perform its functions and heal.


References

Reflexology – The 5 Elements and their 12 Meridians by Inge Dougans.

World Medicine – The east west guide to healing your body by Tom Mont

Images from The International School of Reflexology and Meridian Therapy and Oriental Medicine.

MEET THE EXPERT


Fiona Hardie has owned her own Pilates studio for 18 years in Bryanston, Gauteng where she also does Bowen Therapy, Therapeutic Reflexology, Acudetox, and Bach Flower Remedies. She treats each client holistically taking into consideration their posture and physical state as well as their mental and emotional well-being. She has a special interest in natural pain management, particularly for diabetes and cancer related issues.


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The recipe to a successful patient-provider relationship

Jeannie Berg outlines the responsibilities of both the healthcare provider and patient as a way to a successful patient-provider relationship.


Defining healthcare

Every day, 24/7, people who work in the healthcare industry provide care to millions of patients, from newborns to the very ill thus forming a patient-provider relationship. The healthcare industry is one of largest providers of jobs in most countries around the world. Many healthcare jobs are in hospitals. Others are in nursing homes, doctors’ offices, dentists’ offices, outpatient clinics, private practices, and laboratories. There is a vast range of services rendered by professionals to patients today.

These are our healthcare providers. A healthcare provider is a person or company that provides a healthcare service to you. In other words, your healthcare provider takes care of you.

How healthcare has evolved

The world of healthcare has expanded over the last hundred years. Many things have improved; new discoveries have been made and there is major research being done on so many different aspects of healthcare. What was once thought of as impossible and unthinkable may have now even become the new norm.

Until the 20th century, hospitals were places associated with the poor and where people went to die. The wealthy were treated at their homes by doctors who made house calls 100 years ago. Physicians were not paid by hospitals. They volunteered to treat the poor to help build their reputation. Today hospitals are places of hope and innovation.

In this modern age, many more people have access to healthcare providers and with that comes new challenges.

Positive patient-provider relationship

Patient needs have evolved. Patients are not simply looking to visit their doctors to cure a disease. They now also want a positive patient-provider relationship that yields a positive patient experience. Patient-provider relationships have emerged as cornerstones of quality healthcare.

Trust, knowledge, regard, and loyalty are some of the elements that form the doctor-patient relationship, which has an impact on patient outcomes. There also must be empathy, strong communication, and shared decision-making to ensure a positive patient-provider relationship.

Patients are generally looking for a provider who is knowledgeable, listens to patient concerns, explains medical concepts clearly and in layman’s terms, and spends as much time as necessary during care encounters.

Challenges

Here comes the first challenge: there are simply not enough healthcare providers to go around. However, patients still want their “piece of pie” which they have every right to. Though, “I’m paying for this, you know!” could be articulated in a softer approach.

This makes for many challenges and with COVID taking up so much of all providers’ time, the patient must compromise even more on interaction and time with a provider.

How can we solve this challenge?

Firstly, a patient must try to be prepared for his visit to his healthcare provider. This helps that the minimum time is spent with the maximum benefit.

Being prepared for your visit entails that you have jotted a few of your concerns down so that you can address them with your provider, whether you are visiting a doctor or consulting a physiotherapist.

Concerns would be like: What does my treatment entail? What is the prognosis? How long will it be to get well? What must I do?

Things to consider:

  • Most healthcare appointments need to be made at least the day before.
  • Ask for a longer appointment if you think you will need more time.
  • Be on time for your appointment and be patient if the provider is running late. He/she too is only trying their best.
  • Let the healthcare service know of any preferences you have, such as if you would like to see a female doctor.
  • Ask if there is anything you need to bring with you (such as X-rays) or that you should do to prepare (such as fasting).
  • If you are having multiple tests, find out if you need to have them in a particular order, so that you can book them that way.

Providers have duties. What are they?

  • Consult with patients, discuss their healthcare needs, and offer advice.
  • Diagnose illnesses and offer prognoses as required.
  • Provide a medical service or perform a procedure depending on the patient’s needs.
  • Prescribe medication and/or provide the best course of action.

Patients do have rights. What are they?

  • They have the right to be treated with respect, allowed to obtain their medical records (which is their responsibility to keep safe and private if they keep them on their person).
  • Patients are allowed to make a treatment choice and give informed consent.
  • They can also refuse treatment and can make decisions about end-of-life care.

But patients are not without responsibilities as well

  • Take care of his/her health (and that includes being compliant and adherent to correctly using his medication and following advice given by the provider).
  • Care for and protect the environment. Do not throw those syringes and needles into the trash, for example.
  • Respect the rights of other patients and healthcare providers.
  • Utilise the healthcare system properly and do not abuse medical aid/insurances’ available benefits by fraud and allowing other persons access to their benefits.
  • Use your medical aid wisely. Don’t consult your HCP for things that cost your medical aid unnecessary money. For example, like phoning your doctor for a prescription of deworming medication. This is something you can buy over the counter at any pharmacy.
  • Understand the local health services and what they offer and know how their medical aid works. This is not his provider’s responsibility.
  • For optimum results, they must provide healthcare providers with the relevant and accurate information for diagnostic, treatment, rehabilitation, or counselling purposes.
  • A good idea is to advise the healthcare providers on their wishes regarding death.
  • Compliance with the prescribed treatment or rehabilitation procedures is also a huge responsibility.
  • A patient, even if he/she has medical insurance or medical aid, is still responsible for the payment of any health bills and it is not for the provider to fight this battle for the patient.

Communication, respect and boundaries

When both parties commit to honouring their responsibilities, a patient-provider relationship can be successful. A vital element of good patient-provider relationship is communication. Communication is a two-way street and must always be kept open. It is also important to create clear boundaries.

Providers and patients need be polite, considerate, and honest with each other.

Patients should be treated with dignity and as individuals. Respect patients’ privacy and right to confidentiality. Support patients in caring for themselves to improve and maintain their health.

Providers also need to be treated with the necessary respect, and with both sides paying attention to this a health relationship between provider and patient is possible.

Jeannie Berg

MEET THE EXPERT


Jeannie Berg is a pharmacist and accredited diabetes educator. She served as Diabetes Education Society of South Africa (DESSA) chairperson for four years and was a committee member for many years and served on an advisory board for South African diabetes guidelines as well. She also does online tutoring in diabetes management for The University of South Wales.


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Diabetes and the eyes – prevention is better than cure

Diabetes nurse educator, Kate Bristow, educates us on the normal function of the eyes and how uncontrolled diabetes can damage this.


Before we can identify what is abnormal in the eyes, we need to know what is normal. This is why screening is so important. In eye care, this is a cardinal rule.

The prevalence of diabetes is increasing, especially in working age adults. Fifty percent of people with diabetes don’t know they have diabetes and out of that 50% will not receive treatment or inadequate treatment. Fifty percent of people with diabetes will develop diabetic retinopathy (DR).

What is diabetic retinopathy (DR) and how can we prevent it?

Retinopathy is a complication of diabetes that affects the eyes. DR is caused by damage to the blood vessels in nerve tissue at the back of the eye. If blood pressure and blood glucose levels are consistently high, it can cause serious damage to blood vessels. Blood vessels in your eyes supply blood to the seeing part of the eye which is called the retina.

Damage to blood vessels can cause blockage, leaking or unusual growth of random blood vessels. This means that the retina does not get sufficient blood.

Retinopathy usually develops in stages. Early stages have no symptoms but as the condition progresses you may develop:

  • Floaters or spots in your visual field
  • Blurred vision
  • Dark or empty areas in your vision
  • Loss of vision and difficulty perceiving colours
  • Blindness can occur

What causes diabetic eye disease?

Too much glucose in the bloodstream over time can lead to damage of the very small blood vessels which take oxygen to the eye. This means no blood supply or reduced blood supply to the eye. The eye tries to compensate by growing new blood vessels, which don’t develop properly and leak or bleed into the retina or into the vitreous (gel-like fluid that fills your eye)  that leads to further damage of the retina.

Retinopathy can be early or advanced

Early diabetic retinopathy is called non-proliferative diabetic retinopathy (NDPR). This means new blood vessels are not yet growing in the eye but the walls of the retina weaken and can bulge and leak fluid or blood into the retina. Larger vessels can also dilate and swell. NPDR can progress from mild to severe as more and more blood vessels are damaged.

Sometimes damage to the retinal blood vessels leads to a build-up of fluid causing swelling in the centre of the retina, the macular. This is called macular oedema and if it affects vision, treatment is required to prevent permanent visual loss.

Advanced diabetic retinopathy is also known as proliferative retinopathy where damaged blood vessels lead to starvation of the retina of oxygen, causing growth of abnormal new vessels in the retina. The vessels are fragile and prone to leaking or bleeding into the vitreous.

Scar tissue from the growth of the new blood vessels can cause the retina to detach from the back of the eye. This is called tractional retinal detachment because the retina is pulled off the eye by scar tissue.

New blood vessels (neovascular) can also interfere with the normal function of the eye and pressure can build up in the eye. Raised intraocular pressure damages the main nerve in the eye (the optic nerve) which carries messages from the eye to the brain, resulting in a condition called glaucoma.

What are the risk factors for diabetic retinopathy?

It can be a complication for anyone who has diabetes especially if you have:

  • Diabetes over a longer period
  • Poor blood glucose control and bouncing blood glucose levels
  • High blood pressure
  • High cholesterol in pregnancy
  • Smoking
  • If you are of African descent or Hispanic, the risk is higher.

Complications associated with diabetic retinopathy include

  • Vitreous haemorrhage is when the new abnormal blood vessels bleed into the vitreous of the eye causing floaters or visual disturbances. This is often not permanent and if the retina is not damaged, sight can return to normal after a few weeks or months. Laser treatment is required to regress the abnormal blood vessels and if laser is not possible, surgery to remove the gel (vitrectomy) is done and then laser performed.
  • Retinal detachment happens when the scar tissue associated with abnormal blood vessel growth can pull the retina away from the back of the eye. This causes spots, flashes of light or severe loss of vision.
  • Glaucoma is when new blood vessels grow on the iris of the eye which interfere with normal flow of fluid out of the eye and increased pressure in the eye. This causes damage to the optic nerve.
  • Blindness occurs when diabetic retinopathy, macular oedema, glaucoma individually or in combination leads to complete loss of vision, especially if left untreated.

Prevention is better than cure

Although it is not always possible to prevent diabetic retinopathy, regular eye exams, good blood glucose and blood pressure control and early treatment for problems with your sight can go a long way to preventing severe loss of vision.

Patient education is essential, work with a diabetes nurse educator (DNE) to learn how to better manage other aspects of diabetes. Your DNE is your co-ordinator to the team approach to your diabetes care.

So, in short:

  • Manage your diabetes with a healthy eating plan and a regular exercise routine.
  • Take medications as prescribed and work with your doctors diabetes educator to improve/manage/maintain your blood pressure, cholesterol and glucose control
  • Test your blood glucose levels regularly and aim for targets that you have set with your diabetes medical team.
  • Have your HbA1c (glycosylated haemoglobin) tested regularly and aim for a reading of 7% or below. A decrease of 1% in HbA1c can reduce complications of diabetes, including DR by 33% (that’s a 1/3 decrease in risk because of better blood glucose).
  • Manage weight and blood pressure; healthy lifestyle choices go a long way to helping with this.
  • Quit smoking
  • Reduce/stop alcohol use.
  • If you have diabetes before or develop it during a pregnancy, the risk of retinopathy may be increased, and you may need more regular eye exams during this period.
  • Be aware of visual changes and seek help immediately if you are concerned. This includes blurred vision, or spots.
  • See your eye doctor/ophthalmologist for an annual examination even if your vision is fine. Your pupil will be dilated to allow careful examination of the back of your eye.

Diabetes does not always lead to loss of vision and being actively involved in your own diabetes management is the best way to prevent complications. There are team members out there to guide and support you in this. Ask for help from your diabetes team.

The Ophthalmology Society of South Africa (OSSA) developed the Screen For Life programme for early diagnosis of diabetic retinopathy.

The Screen For Life programme helps communicate these important messages, using three red warning flags.
Sister Kate Bristow is a qualified nursing sister and certified diabetes educator.

MEET THE EXPERT


Sister Kate Bristow is a qualified nursing sister and certified diabetes educator. She currently runs a Centre for Diabetes from rooms in Pietermaritzburg, providing the network support required for the patients who are members on the diabetes management programme. She also helps patients who are not affiliated to a diabetes management programme on a private individual consultation basis, providing on-going assistance and education to assist them with their self-management of their diabetes.


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How to tame ghrelin your hunger hormone

Ghrelin, the hunger hormone, is not your enemy and can be tamed in productive ways. Dietitian, Retha Harmse, explains further.


Hunger is often seen as the enemy and therefore by association the hunger hormone, ghrelin, is demonised and ostracised. The name ghrelin doesn’t do itself any favours though, as it sounds like a gremlin. The Oxford dictionary even defined gremlins as:

  • In early use: a lowly or despised person; a menial, a dogsbody, a wretch (obsolete).
  • Later: a mischievous sprite imagined as the cause of mishaps to aircraft.
  • More generally: such a creature is imagined as the cause of any trouble or mischance.
  • Hence also: an unexplained problem or fault.

But let us take a closer look at this misunderstood and underappreciated hormone.

Meet the hormones

A host of hormones, insulin, leptin, adiponectin, and ghrelin, among others, communicate with the brain’s control centre called the hypothalamus to manage a person’s intake and weight. These regulatory hormones regulate feeding in response to signals from body tissues.

  • Insulin controls the amount of glucose in the blood by moving it into the cells for energy.
  • Leptin, which is produced mainly by fat cells, contributes to long-term fullness by sensing the body’s overall energy stores.
  • Adiponectin is also made by fat cells and apparently helps the body respond better to insulin by boosting metabolism.
  • Ghrelin, the hunger hormone, is produced primarily by the stomach and tells the brain when the stomach is empty, prompting hunger pangs and a drop in metabolism. Ghrelin also increases our cravings and affinity for sugar- and carbohydrate-rich foods (which is a problem for glycaemic control).

Getting to know how the hunger hormone works

This communication of the stomach with the brain happens via the vagus nerve, part of the autonomic nervous system that travels from the brain to the stomach. When filled with food or liquid, the stomach’s stretch receptors send a message to the brain indicating satiety.

It seems easy enough then to lose weight, right? There should just be a drop in ghrelin levels. Unfortunately, it is much more complicated than that. Ghrelin levels are highest in lean individuals and lowest in the obese. Increased levels are seen in people who are dieting. In fact, traditional dieting tends to boost ghrelin levels.

The reasons for this can be debated until the end of time but the short and not at all in-depth explanation is to always remember that our bodies try their utmost best to protect us and keep us alive and safe. In the case of ghrelin, the real threat and danger we are being protected from is starvation. So, what can we do?

How can we tame the hunger hormone?

It is also worthy to mention at this point that interfering with hormones can be extremely dangerous, therefore we would be looking at lifestyle factors instead of hormone-altering treatments.

Carbohydrates

Low concentrations of glucose in the blood showed an increase in ghrelin secretion. However, interestingly though, insulin was also shown to affect ghrelin levels (which might seem contradictory if we understand the link between glucose and insulin production). Further research is needed to fully understand the link, but from what we know now is that instead of the insulin itself, the insulin-sensitivity might be more important to regulate ghrelin levels.

Regular meals that are high in fibre and low in glycaemic index that provide a slower release of glucose into the bloodstream is recommended.

Protein

The connection between protein and ghrelin is less clear. One study found that the ingestion of essential amino acids leads to a continuous rise in serum ghrelin levels, which unexpectedly contradicts other studies that found an inhibitory effect of protein on ghrelin.

Although the connection isn’t clear, adding healthy lean proteins are always beneficial for meals to be more balanced.

Fat

Healthy fats also helped reduce the ghrelin levels in the plasma. Thus adding healthy fats to your meals are recommended as well. Foods that contain omega 3 like fatty fish, chia and flax seeds and nuts will boost leptin and keep ghrelin in check.

Fasting

Total ghrelin level increases at night and decreases after breakfast in humans. Circulating ghrelin concentration rises before a meal and falls after a meal and serum ghrelin increases steadily during long-term of fasting in humans. Eating regular meals and snacks per day will keep ghrelin and leptin levels stable. During crash dieting or calorie restriction, ghrelin levels increase and poor food choices and cravings will increase.

Therefore, fasting is not recommended and regular balanced meals are better for ghrelin-regulation.

Good quality and uninterrupted sleep

There have been numerous studies showing the importance of good quality sleep on weight loss and maintaining a healthy weight. Participants with less than 7 hours of sleep were shown to have higher BMIs and were thought to have increased appetites. The mechanism of leptin and ghrelin might explain those results. To gradually reduce ghrelin, aim for 7-9 hours of sleep each night.

Stress

As stress levels get elevated, ghrelin levels tend to increase (hello sugar cravings during stressful times). Circulating ghrelin levels have been found to rise following stress. It has been proposed that this elevated ghrelin helps the animals in the study to cope with stress by generating antidepressant-like behavioural adaptations, although another study suggests that decreasing the central nervous system ghrelin expression has antidepressant-like effects. 

Engage in activities that help you to rest and relax: spending time outside in nature, engaging in exercise you enjoy, arts and crafts that help you be creative and lastly get feelings off your chest and allow yourself to feel and heal your emotions.

Be friends

  • The hunger hormone is called ghrelin.
  • Ghrelin is not the enemy; it is made to protect your body and protect you against starvation.
  • Traditional dieting and fasting tend to upregulate ghrelin levels.
  • Fasting is also not recommended as it also tends to increase ghrelin levels.
  • Ghrelin levels can be modulated by:
    • Eating a balanced diet with sufficient complex and low glycaemic index carbohydrates, healthy fats and lean proteins.
    • Ensuring regular and adequate meals to prevent hypoglycaemia.
  • Aim for 7-9 hours of sleep per night. Good, uninterrupted sleep is very important.
  • Reducing stress levels in any way that feels good for you.
Retha Harmse is a Registered Dietitian and the ADSA Public relations portfolio holder. She has a passion for informing and equipping the in the field of nutrition. She is currently in private practice in Saxonwold, Houghton and believes that everyone deserves happiness and health and to achieve this she gives practical and individual-specific advice, guidelines and diets.

MEET THE EXPERT


Retha Harmse is a registered dietitian and the ADSA public relations portfolio holder. She has a passion for informing and equipping patients in the field of nutrition. She is currently in private practice in Saxonwold, Houghton and believes that everyone deserves happiness and health and to achieve this she gives practical and individual-specific advice, guidelines and diets.


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How is your kidney function?

Kidney function is one of those things that we seldom pay attention to in diabetes, until it’s too late and costly. This is why Dr Paula Diab advocates preventing kidney disease as early as possible.


Recent data published by the International Diabetes Federation (IDF) shows that there has been a dramatic rise in the prevalence of diabetes in South Africa over the last 10 years from 1,2 million to 4,5 million people.

In addition, it estimates that 52,4% of people living with diabetes are undiagnosed and that by 2030, the prevalence would have risen to over 6 million people. Every year diabetes complications claim the lives of about 90 000 people in South Africa and many of these people are under the age of 60.

Amongst these complications, kidney disease is one of the biggest contributing factors, especially in the African population. It is a costly complication and one that is difficult to diagnose and treat therefore it is really important to prevent kidney disease as early as possible.

What is kidney disease?

Kidney disease (diabetic nephropathy) is caused by damage to small blood vessels in the kidneys, leading to the kidneys becoming less efficient or failing altogether.

Kidney disease is much more common in people with diabetes than in those without diabetes. Although other diseases, such as hypertension, may also contribute towards the development thereof. By maintaining near normal levels of blood glucose and blood pressure, you can greatly reduce the risk of kidney disease.

Why is it so difficult to diagnose and treat kidney disease?

Firstly, kidney disease has almost no symptoms until almost all kidney function is lost. What this means is unlike a respiratory infection, for example, where within days of being infected you develop symptoms of a blocked nose, temperature, sore throat; kidney disease begins insidiously in the body without any noticeable symptoms.

When symptoms do start to develop, they are very non-specific. Common indications are fatigue, weakness, nausea, difficulty concentrating or poor appetite. All of these symptoms have multiple other causes which are often far more common and, even more often, are disregarded by healthcare professionals and patients alike as being of no consequence.

The symptoms that generally alert us to specific kidney problems only tend to occur very late in the disease process when very little preventative therapy can be offered. However, they are important to be aware of and include problems, such as a reduced urine output, shortness of breath, dry, itchy skin and puffy feet and face.

Our other indicator of disease is often blood or urine tests. Once again, in kidney disease, these are non-specific, and changes often only tend to occur very late in the disease. Those people who have diabetes or hypertension should make sure that they have regular (twice a year) blood and urine tests to look for changes in kidney function.

End-stage kidney disease is expensive

“Prevention is better than cure” is an old adage used in medicine, but it has never been more relevant than when talking about kidney disease.

Kidney dialysis is an extremely expensive and time-consuming way of treating kidney failure and yet it’s often inevitable if you don’t pay attention to kidney disease early on. It involves multiple visits to hospital every week and leaves people feeling very tired and weak. Although most medical aids will fund dialysis treatment, the amount of money spent on kidney dialysis annually is enough to provide continuous glucose monitoring to each person living with diabetes in South Africa. Imagine how much better we could control diabetes with such technology!

What can be done?

For many reasons, kidney disease has always been one of those forgotten complications of diabetes that we tend to ignore. Possibly because there wasn’t much that could be done to preserve or treat kidney function. Thankfully, much has changed!

  1. Lifestyle adaptations

Yes, I’m talking about those horrible things like exercise, eating correctly and stopping smoking. It is difficult and involves planning, educating yourself and commitment but it’s still the most effective way of preventing kidney disease. In fact, stopping smoking is probably the single most effective thing you can do to prevent the majority of complications associated with diabetes.

  1. Avoid excessive over-the-counter medication

Many OTC medicines that we all take on a regular basis can have a negative impact on the kidneys especially if they are taken in excess. Be careful of many herbal preparations and ‘health supplements. Other medications that can be implicated are pain medications, some antibiotics and medications for heartburn or reflux. Please rather get these medications scripted by your doctor who can assess if the benefit of the medication outweighs the risk and ensure you are taking the correct dose.

  1. Make sure you take your chronic medication regularly

Diabetes medication is unlike any other chronic disease and requires regular updates and alterations. Please don’t be lulled into taking the same medication year after year and allowing your glucose levels to become uncontrolled. Don’t just expect to have a script rewritten every six months with the same medication; regular updates and changes may be necessary.

Check your glucose levels throughout the day and contact your diabetologist regularly to reassess your condition. Blood pressure medication also needs to be taken daily and re-assessed at regular intervals. Newer medications are now available that can be protective to the kidneys and are highly effective at preserving kidney function so talk to your doctor and find out what is best for you.

  1. See your doctor and healthcare team regularly

When you take your car for a service, you don’t expect the mechanic to repair the dent in the bumper, do the wheel alignment and change the windscreen. These are all specific jobs that all require specialists. The same teacher doesn’t teach all matric subjects and one shop doesn’t necessarily sell all your clothing and grocery needs. Diabetes requires a team approach for the best outcomes to be achieved. Dietitians and diabetes nurse educators play an extremely vital role in complementing and augmenting the services that a doctor can give. Working together as a team also allows for more regular check-ups and preventing diabetes complications from a number of different pathways.

  1. It’s a good investment

As our kidneys have some of the smallest blood vessels in the body, by ensuring those small vessels are well perfused and healthy, you will also be taking care of other small vessels in the body, such as the eyes, nerves and heart. Taking care of the small vessels also ensures that the larger vessels in the heart, muscles and brain are also kept healthy.

Final say

In conclusion, treating kidney disease is costly. It can be difficult to diagnose and may only be picked up in the late stages of the disease. But, it can certainly be prevented through good lifestyle choices and preventative medication. Take control of your own health and well-being and speak to your doctor about what can be done to ensure that you prevent any further damage to the kidneys.

Dr Paula Diab

MEET THE EXPERT


Dr Paula Diab is a specialist family physician who enjoys the challenges that diabetes management has to offer. She runs a multi-disciplinary practice in Kloof, KZN, where she works with patients with diabetes and their families to allow them to gain control of their disease rather than being overwhelmed by the complexities and complications often associated with diabetes.


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What is diabetic gastroparesis?

Diabetic gastroparesis is a severe complication resulting from uncontrolled diabetes that impairs quality of life. Dr Louise Johnson expands on this debilitating condition.


Gastroparesis definition

Gastroparesis is characterised by delayed gastric (stomach) emptying in the absence of mechanical obstruction. This is associated with uncontrolled diabetes. It is more prevalent in Type 1 diabetes than in type 2 diabetes.1

Clinical

The prevalence of diabetes associated gastrointestinal symptoms are 5-12%. In a study, done in Olmsted County, Minnesota, the prevalence of gastroparesis in Type 1 diabetes was 5% and in Type 2 diabetes the prevalence was 1%. 2

Gastroparesis is a form of autonomic neuropathy (nerve damage) and is most common seen in people with diabetes longer than 10 years. They usually have microvascular (small blood vessel) complications to the eye, kidney and feet as well.

The most common symptoms are nausea, bloating, abdominal pain and vomiting. The reason for these symptoms is due to delayed pass through of food and liquids from the stomach to the bowel. This is usually due to long-standing poor glycaemic control.

What causes the delay?

In the stomach there are specialised cells called Cajal cells that function as the electrical pacemaker of the stomach. Due to high blood glucose these cells are damaged, and this leads to gastroparesis.

The symptoms of gastroparesis can range from mild to severe and incapacitating. The diagnosis is not always easy as early on a person may be asymptomatic. Early symptoms are early satiety, weight loss, abdominal pain, bloating, nausea and vomiting.

Pain is under-reported and up to 75% of patients with gastroparesis experience abdominal pain.

In a study3 that looked at gastroparesis trends from 1995 to 2004, a 53% increased risk of diabetes-related hospitalisations was attributed to gastroparesis. This condition may also indicate a higher risk of other diabetes-related complications.

Some patients with diabetes may not realise that they experience delayed gastric emptying but exhibit unpredictable responses to mealtime insulin. These responses result from a mismatch between food absorption from the stomach that is slowed down and insulin absorption that is not slowed down. The result is hypoglycaemia early after a meal and a few hours later an unpredictable hyperglycaemia.

In Type 2 diabetes patients who take Glucagon-like peptide-receptor agonists (GLP1 RA), such as exenatide, liraglutide, dulaglutide, semaglutide, the symptoms may be exacerbated since these drugs cause gastric (stomach) delay. This is used in Type 2 diabetes that have increased stomach emptying and tend to overeat and pick up weight.

Diagnosis

The typical complaint associated with gastroparesis is a feeling of excessive fullness after eating, which can last for hours or even overnight. Patients may also complain of feeling full or satiated sooner than expected. When symptoms progress some may even vomit undigested food hours after eating. These symptoms can occur after any meal.

The first test to do is a gastroscopy (swallowing of the camera) to rule out stomach outlet obstruction. Once a mechanical obstruction is ruled out the next step is to measure the time it takes for food to move from the stomach to the small bowel. This is called a gastric motility test.

Patients fast overnight and are not allowed to drink alcohol the night before. Blood glucose should also be below 15 mmol/L. The patient then eats a low-fat egg-white sandwich and special images of the transit time of the food are taken up to 4 hours after eating. When the test is completed and there is more than 10% food left in the stomach after 4 hours, the diagnosis of delaying gastric emptying or gastroparesis is made.

Treatment of diabetic gastroparesis

Non-pharmacological

The first line of treatment for gastroparesis includes dietary modification, glucose control and restoration of fluids and electrolytes.

Foods that are spicy, acidic and fatty should be avoided or minimised because they may worsen symptoms. Carbonated beverages can aggravate the distension of the stomach. Smoking and alcohol slow down stomach movement and should also be avoided. It is suggested to visit a dietitian and eat smaller, more frequent meals.

In more severe cases, feeding needs to be substituted by liquid feeds and in very severe cases hospitalisation and feeding via an intravenous line (drip).

It can be quite challenging to control blood glucose in a person with gastroparesis. It may be necessary to change the mealtime insulin by giving it after a meal to prevent hypoglycaemia. In certain cases, the use of an insulin pump and sensor is very effective by giving small doses of insulin as needed and suspend insulin when blood glucose will go low.

Pharmacological

  1. Metoclopramide before each meal will help with faster emptying of the stomach.
  2. Domperidone before each meal will help with faster stomach emptying.
  3. Erythromycin three times a day before each meal help with stomach emptying but this can’t be used longer than four weeks. It can also aggravate nausea.
  4. Surgically there is a pacemaker that can be implanted in the stomach to help restore the stomach functions. This is unfortunately very expensive and still very new therapy.

Diabetic gastroparesis is a severe complication resulting from uncontrolled diabetes that impairs quality of life and increases comorbid conditions and mortality. Remember that good glucose control can prevent this complication. It is important to take care of your diabetes and know your numbers (HbA1c). Seek the help of a specialist team to optimise your health and all your diabetes complications.


References

  1. Krishnasamy S, Abel TL “Diabetic gastroparesis principles and current trends in management.” Diab Ther 2018;9 p1-42
  2. Jung HK, Choung RS et. al. “The incidence, prevalence and outcomes of patients with gastroparesis in Olmsted County, Minnesota from 1996 to 2006” Gastroenterology 2009;136: 1225-1233
  3. Wang YR, Fisher RS et. al. “Gastroparesis -related hospitalizations in the United States: trends, characteristics, and outcomes, 1995-2004” Am J Gastroenterology 2008;103:313-322
Dr Louise Loot

MEET THE EXPERT


Dr Louise Johnson is a specialist physician passionate about diabetes and endocrinology. She enjoys helping people with diabetes live a full life with optimal quality. She is based in Pretoria in private practice.


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Pandemic sees increase in weight gain

A survey, commissioned by Pharma Dynamics, confirms an increase in weight gain in more than half of South Africans during the pandemic, with 69% bordering on obese.


While the intention of lockdown regulations and physical distancing was to contain the spread of COVID-19, the unintended consequences have been an economic crisis, record-high unemployment and a ‘larger’ population.

Survey results

A national survey conducted in the last two months among almost 2 000 South African adults paints a dire picture:

  • 45% of respondents said lockdown regulations impacted their eating and exercise habits for the worse.
  • 44% picked up between 2-5 kg; 15% are 6-10 kg heavier and 4% gained an extra 10 kg or more.
  • 58% of family members (spouse/children) also packed on a few pounds.
  • Increased weight gain in 15% of pets were also reported, which has equally real health consequences.
  • 34% said their diet consists mainly of takeout and ready-made meals, while a further 30% said they eat what they can afford since their income has been impacted.
  • 42% are exercising less than before the pandemic.
  • 59% are currently on medication for a comorbidity such as heart disease, diabetes or hypertension.

About the survey 

The survey was commissioned by Pharma Dynamics, the largest provider of cardiovascular medicine in the country, to assess the effect of the pandemic and the subsequent lockdown on the nation’s eating and exercise patterns.

Nicole Jennings, spokesperson for Pharma Dynamics, says they are concerned about the long-term, negative effects that lockdown regulations have on SA’s obesity epidemic.

“Treats and calories are up, while exercise is down, which is never a healthy combination. Limited access to daily grocery shopping may have led to reduced consumption of fresh fruit and vegetables in favour of highly processed food. In times of stress and uncertainty, people also find solace in comfort food, which tends to be low in nutritional value and high in carbohydrates, fats, salt and sugar.”

Forty-three percent of respondents who participated in the survey attributed their change in eating habits to stress and anxiety over what the future holds, while 42% said being confined to their homes also led to more snacking and impulsive eating, and 28% simply ate out of boredom.

Jennings says the constant bombardment of COVID-19-related news is stressful, and stress leads to overeating. “Comfort foods can reduce stress as they encourage dopamine production, which has a positive effect on mood, although, they’re not good for your health.”

The nation’s jump in weight the last 12 months significantly increases the population’s risk of hypertension, which already stood at 35% before the pandemic.

69% bordering on obese

Jennings notes that participants were asked to calculate their body mass index (BMI), a measure of your weight compared to your height. The findings indicated that 69% (almost seven in 10) respondents polled, ranged between overweight and obese.

“Female obesity rates align with previous data collected in 2019 by another health provider, but men seem to have really struggled with their weight during the pandemic. Based on our survey, obesity rates among men climbed by 40%.”

The lockdown has also expanded children’s waistlines. Interrupted schooling and extra-curricular activities have led to 43% more screen time as many parents had to attend to work responsibilities leaving children to their own devices. Children have also become more sedentary, and many adopted unhealthy eating habits in the process.

The SA National Health and Nutrition Examination Survey (NHANES) currently reports a combined overweight and obesity prevalence of 13,5% in children between 6-14 years of age, about 10% higher than the global prevalence.

Obesity needs to be tackled with vigour

“The likelihood of hypertension developing in those who are obese is almost certain and it can result in serious health problems that are even more life-threatening than COVID-19,” says Jennings. “To put it into context, every year, 10 million people die due to hypertension complications alone, almost four times more than those who have died from COVID-19. While COVID-19 remains a public health threat, concurrent epidemics, should not be neglected. The same attention, vigour and resources should be applied at tackling obesity.”

“While a sugar tax has been introduced, there is a need for additional legislative changes that focus on societal factors and the food industry. Health policymakers need to take bolder and more definitive steps to curb obesity. Without decisive leadership, it won’t be reversed. Solely relying on public health messages about calorie intake, diet and exercise isn’t enough. A disconnect remains between policymakers and communities that struggle with obesity, especially among those living in low-socioeconomic areas, where unemployment and poverty levels are rife. Political advocacy and action to disrupt entrenched cycles that maintain poverty and prevent access to healthy choices is what is needed.”

“SA’s obesity-associated costs already stack up to an estimated R53,9-bn per annum, which puts a tremendous strain on our already fragile healthcare system.”

Can these habits be changed?

While the vast majority (88%) are aware that obesity heightens a person’s risk for severe COVID-19 complications, 19% of those polled said they won’t be making any attempt to address their weight issues.

Jennings says it’s clear that the lockdown promoted dysfunctional eating and sedentary behaviours, which need to be overturned.

“Yes, it’s going to be tough to change habits after a year of comfort-eating, but unhealthy lifestyle habits threaten our health. With many still working from home, confined to small spaces, and the rapid increase in door-to-door delivery services, physical activity, such as going out for a walk during lunchtime or popping out to do some grocery shopping may be even more constrained. Similarly, consumers’ reliance on fast-food delivery services have increased substantially since the pandemic with many a diet solely consisting of junk food. Should the pandemic trend prevail, obesity may get much worse.”

“Moving towards a healthier lifestyle is crucial, especially while we are still battling COVID-19. We need to give our immune systems everything it needs to fight back. When obese, your body is in a constant state of inflammation. Just a modest amount of weight gain in people who are hypertensive can increase their blood pressure to dangerous levels, which puts strain on their hearts and overall health.

“As with most habits, it takes time to establish. Now that everyone is accustomed to the new normal, let’s be proactive about establishing new, healthier habits to see us through the pandemic,” urges Jennings.

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DSA News – Spring 2021

DSA Port Elizabeth news

Changing Xabiso’s life

Paula Thom, convenor of the DSA Young Guns, was recently contacted by the brother of a high school learner, Xabiso. He was orphaned a few years ago and his Aunt Nomonde looks after him. Xabiso was diagnosed with Type 1 diabetes a year ago. His brother appealed for help in educating Xabiso and Nomonde in diabetes care and healthy eating. Xabiso had been admitted to hospital a few times already with hypoglycaemia.

Paula and Pamela Molefe went to Xabiso’s home in Motherwell to visit him and his aunt to see how we could assist them. Their biggest need was for a glucometer, healthy food for Xabiso and also clothing. An appeal was placed in the PE branch newsletter, Sweet Talk, and also on the DSA Young Guns Facebook page. Within a few days many responded, mainly from the DSA Young Guns.

On Saturday, 7 August 2021, Martin and Elizabeth Prinsloo and Pamela, who speaks their home language, took the gifts to Xabiso. One can feel the love and caring they have for one another in their home. He was given a brand-new glucometer, testing strips, needles, sweeteners, breakfast cereals, milk, fresh vegetables, booklets explaining diabetes care  and clothing to name a few items. Diabetic Accessories also donated a lovely gift hamper. The money has been banked in a sub-folder of our DSA branch account so that our branch  will be able to provide him with testing strips as needed.