"No, no, no! That is yet another dangerous myth that unfortunately, a lot of people still believe in," Dr Manish Tripathi says, when I ask him whether a calcium-rich diet could affect the kidneys. With over 15 years of clinical experience under his belt, it’s no surprise that he has come across his fair share of myths and beliefs related to the renal issues.
"I have had several patients who suffered from different kinds of renal conditions just because they had fallen for misconceptions related to kidneys and their functioning."
The Specialist Nephrologist in Medcare Hospital Sharjah explains the dangers behind the belief that a calcium-rich diet must be avoided to reduce the chances of developing kidney stones. "On the contrary, people must actually include a calcium-rich diet in their meal plans," he says.
A hormone called Parathyroid Hormone (PTH) helps regulate the calcium and phosphorus levels in our blood. In some cases, when the calcium levels in our blood decreases, the PTH levels increase and it starts taking the calcium from the bones to maintain the calcium levels in our blood. This calcium finds its way to the kidneys and, rather than being flushed out, gets accumulated there. This accumulation of calcium leads to the formation of kidney stones. "So, it is a myth that calcium-rich diets must be avoided at all costs," he says.
Dr Manish says he often advises his patients to increase their intake of calcium-rich food products such as yoghurt and milk. "Kidney stones are usually reported in people aged between 20 and 40 years as it is around this time that they start reducing their intake of food items rich in calcium [and rely more on junk food]. So, I usually advise most of my patients to develop a habit of consuming calcium enriched products."
Excerpts from Friday’s interview with Dr Tripathi:
Does the popular belief that "everyone needs to have eight glasses of water a day" really based on any scientific/biological grounds?
There is no yes or no answer to this. The eight glasses of water belief is just a simple and basic way of informing the general public that you need to consume an adequate amount of water a day.
As doctors, we usually advise normal, healthy individuals to drink around 2.5 to 3.5 litres of water a day. However, do keep in mind that a lot of factors come into play here. Males are generally recommended to consume a higher intake of water, around 3-3.5 litres a day, as men perform more active work outdoors. Women, depending on their body composition, are usually advised to consume around 2-2.5 litres of water a day. Another thing to keep in mind is that, these numbers don’t only pertain to water intake. It can also include other liquids like tea or coffee, and fruits and vegetables that have high-water content like watermelons, grapes, spinach.
These numbers are just a rough estimate as to how much of water is required. Given today’s ever-changing environment and atmosphere, an individual’s water intake will depend on multiple factors such as their activity level, the amount of work they perform, how strenuous their daily activities are, whether they exercise on a regular basis, if they have any underlying health conditions, and the region where they live, among others.
It’s common sense that those people who lead an active lifestyle will obviously consume more water as opposed to those who lead a more sedentary lifestyle as the former will lose a lot of body water through sweat and respiration. A person who suffers from any underlying kidney or heart-related medical conditions are often told to reduce their water intake. Also, people who live in cold regions will naturally consume less water as compared to those who live in tropical regions of the world.
Is yellow urine a sign of dehydration?
Before I answer this, let me tell you the reason behind urine’s yellow colour. Urochrome, a pigment present in urine, gives it the characteristic yellow-amber colour.
So, if your urine is dark yellow, this means your urine is concentrated and it shows that you haven’t been drinking enough water. A lighter coloured urine is a sign that you have been keeping yourself hydrated.
However, there are certain medications or even food items that can alter the colour of your urine such as certain berries, multi-vitamin tablets that can cause your urine to appear darker yellow shade.
If you aren’t under any medication or if you aren’t consuming certain fruits or vegetables that can alter the colour of your urine, then yes, the colour of your urine can roughly be used as a parameter to determine if you are staying hydrated or not.
Is it true that if one urinates frequently, one can be sure that he/she has healthy kidneys?
This is another false belief. On the contrary, urinating more than an average amount can actually be a sign of an underlying kidney disease.
The frequent passage of urine is often attributed to the kidney’s failure of not being able to concentrate the urine as well as absorbing the useful elements from it and this may present itself as Polyuria.
People who suffer from diagnosed or undiagnosed diabetes may also show signs of Polyuria as well.
Of course, people who consume more water naturally urinate more but make sure that the amount of liquid intake more or less equals the number of times you urinate. You shouldn’t be urinating frequently when your average water intake is low. If it happens, consult your GP on what could be the plausible reasons behind this.
Is pain the only symptom of a renal condition?
First, a brief overview of our kidneys before I answer this question.
The two kidney-bean shaped organs inside our body are surrounded by an outer-covering called renal capsule, which is rich in nerve supply. When the kidneys are infected, inflamed, or swell up due to a bacterial infection (pyelonephritis), the renal capsule may stretch, resulting in pain.
In kidney-stone patients, the kidney stones are found in the ureter and this is what causes pain. So, no, you can’t say that all renal conditions will present itself with pain as a symptom. In fact, this is why nephrologists usually urge the general public to get their kidneys checked regularly. Kidney diseases, especially chronic kidney diseases, are often termed as ‘silent killers" as they don’t present any symptoms till the advanced stage.
This is also why we have many campaigns and awareness programmes related to the kidney health every year. It is important to educate and inform people about renal diseases and to encourage the public to get an annual kidney check-up done to detect any problem.
Dialysis is the only treatment for kidney disease. Is this true?
No, dialysis is just one of the treatments for kidney conditions. Dialysis is prescribed when the kidneys lose 80-90 per cent of their ability to filter out waste materials from our body.
This technique of artificial filtration is of two types – haemodialysis and peritoneal dialysis, where the latter is slightly more advantageous as it can be done at home, without frequent visits to the hospital.
In cases of an acute kidney disease, people will be prescribed dialysis for just a short amount of time, during which the kidney gets back to normal in a relatively short span of time. In many cases of a chronic kidney disease, due to various factors, the kidneys gradually deteriorate and hence, dialysis once opted, maybe lifelong.
However, there are many people who believe that once you are on dialysis, your life is pretty much done for. That is completely untrue. In the UAE itself we have people visit their dialysis centres and undergo dialysis for the stipulated time and then carry on with their day-to-day work.
Of course, a more permanent treatment option for any renal disease is a kidney transplant. An individual who has both kidneys damaged due to any kind of underlying condition can opt for a kidney transplant if he/she is able to find a perfect donor. A kidney transplant ensures a slightly better quality of life when compared to having to undergo dialysis.
A lot of my patients often believe that the minute they are detected with a kidney ailment, they would need to undergo dialysis. That is also not true. In the initial stages, a nephrologist will aim to safely delay dialysis for as long as possible.
An analysis of various parameters of the patient like blood sugar, blood pressure, creatine levels, heart rate and BMI are done. Based on those results, we will offer medication to control those parameters and bring those readings to normal and help maintain the health of the kidneys as well. If these parameters are not checked or maintained, the progression of a renal disease will be faster and the patient may need to undergo dialysis.
I have had patients who have managed to control the progression of their kidney diseases for five to 10 years without the need of dialysis, but of course, they will be on medications to maintain the functioning of their kidneys.
Does diet and/or lifestyle play a role in preventing or reducing the susceptibility to renal diseases?
Yes! Diet and lifestyle are in fact the most important parameters to keep in mind when talking about susceptibility to renal diseases.
Exercising regularly helps keep your body fit, increases blood circulation throughout your body, and helps your body improve its immune system as well. Maintaining a healthy diet that includes fruits and vegetables will not only help your kidneys but also every other organ in your body, thereby ensuring every part of your body is healthy and fit.
The three risk factors for developing any kind of kidney disease, which sadly, are the most prevalent ones within the UAE, are diabetes, hypertension and obesity. So, by taking the time to plan your meal well and including regular physical activity in your life, you are reducing the chances of developing these risk factors, which indirectly also reduces the chances of developing any kind of a renal disease.
At what point should an individual check with his/her GP with any concerns relating to his/her kidneys?
Usually, individuals approach their GP only when they seem to be suffering from some sort of pain or discomfort. But renal diseases are silent killers. They usually don’t present any kind of symptoms and/or pain in the initial stages.
So, to ensure kidneys are healthy and working fine, get a kidney screening done annually. Usually, we recommend people from the age of around 20-25 years to start visiting their clinics for a check-up as many of the risk factors tend to present themselves in ages as early as 20.
The check-ups and/or diagnoses are not intensive or overwhelming. A blood-sugar and blood-pressure check, a urine test, and in some cases, an ultrasound scan will give the nephrologist an idea of the kidneys’ health. Any abnormality will be further evaluated.
Are renal issues a serious problem in the UAE? Are any particular sections of society/ethnicities more prone to renal conditions?
Renal issues are sadly one of the most serious problems in the UAE. Since diet and lifestyle play such a major role in maintaining the health of the kidneys, in today’s ever-changing world, this health condition seems to be on the rise.
Asians, African Americans and Hispanics are more predisposed to renal diseases due to higher chances of being diagnosed with health conditions like diabetes, heart conditions, obesity among others. This can be attributed again to lifestyle, work ethic, food intake as well as lack of awareness and, in some cases, access to healthcare as well.
With the population in UAE being extremely career driven to the point where a majority of them neglect their mental and physical health, over-indulging in a lot of junk food as well as lack of regular medical check-ups are just some reasons that can predispose the general public to the earlier mentioned major risk factors.
Obesity and hypertension are on the rise and it is important that we all include regular exercise as part of our lifestyle.