Slipped disc — how to manage the pain

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14 OCTOBER 2014

The key to a better quality of life when you suffer from a slipped disc is learning to manage the pain

At 25 years old, being diagnosed with a slipped disc was not part of Aini’s plan. Newly married and with a promising career in a Fortune 500 company, Aini and her family didn’t react too well to the news.

They were worried about how she would cope with the diagnosis and if she would be able to lead a normal life.

However, the doctor assured her that with proper information and education, her condition would be manageable.

Slipped disc, also known as a prolapsed intervertebral disc or herniated disc, occurs when one of the discs in the spine ruptures and the gel within leaks out.

A disc prolapse can happen at any part of the spine and when it occurs, pressure is exerted on the nerve closest to it. The lower back (lumbar region) is the most common area for a slipped disc to occur.

The pressure exerted on the lumbar nerve is what causes severe pain and tingling sensation, which often radiates or “shoots” down to the calf and foot.

WORSENING PAIN

Aini’s pain started in March, just three months after her wedding. The pain was localised on the right side of her lower back but she didn’t think too much of it and figured it would soon pass but, as the days went by, the pain worsened.

Her muscles became tensed, causing her to lean to her right side and she was unable to straighten or stand up straight.

She started to feel pain from her back travelling down to her right calf. Often the pain was excruciating and kept her awake at night.

She described it as “someone taking a knife and stabbing me over and over again on my legs. It drove me crazy and I couldn’t sleep. Exhausted and drained from the pain, I couldn’t go to work. “

The unbearable pain left her with no choice but to finally consult a doctor.

She visited doctors at two different clinics and both provided the same diagnosis — that it was nothing more than regular back pain caused by lifting heavy items. Both doctors prescribed painkillers, which didn’t ease her suffering.

When she was finally referred to consultant orthopaedic and spine surgeon Dr Ozlan Izma Muhamed Kamil in mid-April, she was diagnosed as having lumbar disc prolapse.

Even though Aini was mentally prepared for surgery, Dr Ozlan assured her it was not necessary at this stage — proper medication would be sufficient to treat the pain.

“I was told that I had to change everything in my life, from my car to the chair I sit on at work. I started to panic when I thought of all the adjustments that I would have to make in my life but, with Dr Ozlan’s guidance on pain management, my family and I gained a more positive outlook and in the end, I only had to make a few minor changes. Part of my pain management included being aware of how long I sit — I make it a point to take a walk around the office every hour so that I do not remain seated for too long, said Aini.

OTHER CONCERNS

Aini had another concern. Would her new condition affect her chances of getting pregnant?

Dr Ozlan said: “It is not advisable for her to get pregnant while on medication. However, her condition is not permanent and nerve pain from the slipped disc will go away. One major misconception is that people with this medical condition should take extra precautions and limit their physical activities.

“This is not true because with proper medication and light exercises, patients can go about their daily routines without problems.”

With some lifestyle adjustments and the correct medications to help reduce pain, patients should be able to get back to their normal activities as soon as possible and recover eventually.

Lumbar disc prolapse is just one of the many causes of nerve pain. Others include shingles, diabetes, fracture, stroke, cancer and HIV.

Nerve pain happens when there is injury to the nerves, spinal cord or brain.

There are countless nerves in the body which make up your nervous system. These are like a series of electrical wires connecting your brain and spinal cord to the rest of your body.

PREVENTING SLIPPED DISC

Dr Ozlan says: “Be careful with the way you carry heavy items. Don’t overexert yourself, exercise regularly and sit up straight. Good posture is very important.”

In Aini’s case, her suffering was prolonged because she did not seek treatment early and when she did, she was misdiagnosed.

Another tip is to keep a pain diary: When did it start? Also note the nature and severity of pain and any aggravating or relieving factors.

All these can help your doctor with diagnosis and to provide treatment accordingly.

More details at www.knowyourpainasia.com

Symptoms of slipped disc include:

. Pain (shooting, burning, electric shock-like) and tingling sensation, most commonly on one side of the limb.

. Pain that extends to your arms and/or legs.

. Pain that worsens at night.

. Pain that worsens after standing or sitting.

. Pain when walking short distances.

. Unexplained muscle weakness.

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Negative reactions to cow’s milk

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BY FIRDAOUS FADZIL - 1 JULY 2014

ISAAC, a four-month-old boy, was suffering from eczema behind his ears and on his hands. Unaware that those were symptoms of cow’s milk protein allergy, his mother Carmen Low thought that this was common in babies until her paediatrician advised her to give her son soy-based formula instead of the ones derived from animals.

“We thought we were giving him the best by giving him the most expensive formula,” she said.

She started to introduce a soy-based milk to Isaac and after about three weeks, Isaac’s eczema had subsided and he started to look healthier and was even more active.

In a recent workshop sponsored and organised by Abbot Nutrition Malaysia, titled Conquering Cow’s Milk Protein Allergy In Children, consultant paediatrician Dr Khairul Zaman Omar and dietitian Indra Balaratnam gave a better understanding of the allergy among children. The event highlighted the importance of recognising the symptoms of the allergy, the diagnosis and its management in children.

The condition is a result of an adverse immune system reaction to the proteins found in cow’s milk.

Dr Khairul said that cow’s milk has been found to be the most common food allergen in Asia, including in Malaysia. Approximately five to 15 per cent of children develop adverse reactions to cow’s milk within the first three years of life.

Symptoms can vary from mild to moderate, and hence, can affect childhood development. It could even be life-threatening.

SIGNS AND SYMPTOMS

Explaining that it is one of the most prevalent but difficult to diagnose of food allergies, Dr Khairul said there is no definitive blood test to diagnose the allergy and history is the only key.

“The symptoms can affect gastrointestinal organs, the skin and respiratory tract, and can manifest as colic, loose stools, constipation, blood in stool, vomiting, eczema and so on. In Malaysia, there seems to be a trend to ignore the milder symptoms of blocked noses and sneezing in the morning; the coughing when crying, or when there is change in environmental temperature,” said Dr Khairul.

He stressed that those are often symptoms of an allergy and, specifically, cow’s milk protein allergy.

Therefore, parents should contact their paediatrician once they notice any of those symptoms. At this stage, they must share with the paediatrician their own family allergy history as this condition may have been passed on to the child. “The most common risk factor in developing the allergy is a parent with the allergy,“ said Dr. Khairul.

He pointed out that seborrhoea (eczema of the scalp) is commonly misdiagnosed as an infection, and treated with antibiotics, when it is often actually a symptom of cow’s milk protein allergy.

Food allergies are on the rise and parents need to take an active role in looking out for any negative reactions to ensure that their children develop properly.

“The advice is to reduce the risk. When your child is diagnosed with cow’s milk protein allergy, he should stop consuming cow’s milk,” said Dr Khairul, as he advised parents to take the route of preventive medicine.

AN ALTERNATIVE

Alternatively, parents can opt for soya-based milk formula, extensively pre-digested protein and amino acid modified formulae as alternative options.

“Many parents falsely believe that cow’s milk formulas are superior for children, so they feed their children who are milk intolerant with goat or sheep’s milk,” said Dr Khairul.

Goat’s milk is no substitute for cow’s milk when it comes to feeding a child with cow’s milk protein allergy.

“Goats and cows are both mammals, and it is only the size of the molecules that vary. The truth is that if a child has cow’s milk protein allergy, there is a significant possibility they will react to the goat (and sheep) milk too because of the similarity of the protein found in all of them.”

When discussing liquid milk substitutes in a cow’s milk protein allergy-friendly diet, Indra explained how soy-based formulas support normal growth and development in children just as well as cow’s milk-based formulas and are a safe and effective alternative to use for feeding of children with the allergy.

“In the market there are other substitutes for liquid milk, that are fortified with vitamins and minerals. I myself recommend these, because it’s a nice way of including them in your child’s diet,“ she said.

It is also a common misconception that soy milk is the same as soy-based formula.

“Soya milk lacks key nutrients, especially an essential amino acid, which the body needs for the proper growth and development of the child. Some preparations of soy milk have too much sugar which is not beneficial to growing children and that is why soy-based formulas could be the best alternative as they contain all the nutrients needed for children and keep cow’s milk protein allergy at bay.

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How vaccines provide protection

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BY KASMIAH MUSTAPHA - 14 OCTOBER 2014

An expert tells Kasmiah Mustapha about the importance of vaccination and dealing with infectious diseases

AN epidemiologist and expert on preventive medicine, Dr Eddy Bresnitz has led numerous emergency response efforts throughout his career, including the West Nile and SARS outbreaks and anthrax attack.

An advocate for disease prevention and global health, he is a firm believer in vaccination as a life-saving intervention that can help prevent sickness, disability and death.

Currently the executive director of Adult Vaccines and Global Medical Affairs and Policy at Merck, Dr Bresnitz talks about dealing with infectious diseases and the importance of vaccination.

How can we prevent the outbreak of infectious diseases?

The simple answer is by preventing the transmission of diseases thorough a multi-faceted approach.

First and foremost, a country needs to have a comprehensive and functioning public health infrastructure to ensure the distribution of clean water and safe food, since food and water are one of the most common vehicles for disease transmission.

Second, the population, from children to adolescents to adults, needs to be vaccinated against all vaccine preventable diseases to protect the individual directly, and also indirectly through herd protection.

There has to be a good surveillance system in place to monitor the incidence of disease, track contacts of infected individuals and to respond to increases in disease incidence, including outbreaks, to target control measures.

Finally, there must be adequate medical care to provide timely isolation and treatment of individuals to reduce the risk of transmission of disease to others.

What are the challenges in dealing with emerging and re-emerging of infectious diseases?

The biggest challenge is complacency, thinking that everything is under control or what looks like nothing more than a spark is really a small fire ready to explode.

The current ebola outbreak is a good example of that. What started out as a few cases in one country has now resulted in over 3,000 reported cases with over 50 per cent mortality in at least five countries (that we know of) and no prospect of controlling the outbreak in the immediate future.

The ongoing disease transmission of this deadly virus has many contributing factors. From my perspective, the main one is lack of adequate healthcare infrastructure including healthcare facilities, personal protective equipment, personnel, and appropriate control policies.

Adding to the chaos is an apparent distrust of government, poverty and cultural norms that can facilitate the transmission of disease.

With cases of ebola and Middle East Respiratory Syndrome (MERS), there are worries that more infectious diseases will become pandemic. Is that what’s going to happen?

We have witnessed many novel disease outbreaks in the last few decades where there has been significant person-to-person spread globally.

In addition to ebola and MERS, we had SARS, pandemic H1N1 flu, dengue and chikungunya.

With increasing urbanisation, population growth and ageing, global warming, global travel, food insecurity and the prevalence of social determinants of disease — such as income inequality and differing cultural norms — and the constant evolution of biological organisms and pathogens, we can expect to continually confront infectious diseases that do not respect geopolitical boundaries.

Can vaccination protect a person from infectious disease? How does it work and are there vaccinations for all infectious diseases?

Currently, there are many vaccines capable of providing protection to individuals, targeting close to 30 different diseases. Many of these have different formulations that allow for different modes of administration (intramuscular injection, subcutaneous injection, intradermal injection, oral ingestion, nasal instillation) or are combined with other vaccines to facilitate vaccination.

But no vaccine is 100 per cent efficacious. The reasons are complex but involve some aspect or a combination of factors related to the vaccine, the infectious agent and the individual.

Vaccines tend to work better in younger people because they have younger immune systems which tend to become less responsive to vaccines with age.

This concept is called immunosenescence. Through various approaches such as higher antigen content of the vaccine, the use of adjuvants to bolster the immune response to the antigen and intradermal injection, the immune system can be stimulated to have a higher immunologic response.

If there are no vaccines, how can we protect ourselves against infectious diseases?

There are infectious diseases for which there are no vaccines or, for some reason, there are insufficient supplies of vaccines. For example, there are currently no licenced human vaccines for preventing mosquito-borne organisms such as West Nile virus, chikungunya, and malaria.

I strongly believe that the most important approach to preventing mosquito-borne diseases, even when a vaccine is available (such as yellow fever and Japanese encephalitis) is good environmental control. This lowers the risk of transmission by either reducing the disease vector, in this case the mosquito, or reducing the opportunity for contact with the individual.

Environmental control can reduce the factors which support the breeding of mosquitoes, while personal protective controls (clothing, mosquito netting and insect repellant) reduce the opportunities for mosquitoes to bite the individual.

Even if a vaccine exists, environmental and personal protection controls are equally, if not more important, in reducing the risk of disease since vaccines are never 100 per cent effective.

For food and water-borne diseases, aside from ensuring good public health infrastructure, basic things that can help are cooking food properly, washing hands before and after eating and using the bathroom, keeping an appropriate distance from people who are ill with certain communicable diseases, practicing safe sex and other measures.

Dengue cases here are on the increase annually. What is your advice for dealing with this?

With climate warming, the natural habitat for mosquitoes is increasing and dengue is the most common mosquito-transmitted disease.

Dengue transmission has increased thirty-fold in the last 50 years and has been reported in over 100 countries globally, with estimates of as many as 528 million cases annually. The reasons are already mentioned earlier. Without a licensed vaccine, (although there is one in the horizon with demonstrated efficacy in clinical trials in Asia and Latin America), the major approaches to prevention are as discussed in the above answer.

Do adults need vaccination? If so, what types of vaccination should they have?

Vaccination is important for disease prevention throughout our life cycle. Many countries, including Malaysia, US, Australia, Canada, and the UK, have comprehensive recommendations for vaccinating adults. There are many vaccines which are currently licensed for preventing disease in adults. They should consult a doctor to find out what is best for them.

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Good gut feeling for health

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BY PROFESSOR DR POH BEE KOON - 14 OCTOBER 2014

A healthy digestive system starts with proper nutrition, writes Professor Dr Poh Bee Koon

WHEN was the last time your child visited the toilet? What did he eat or drink before that?

You may not realise it, but the food and fluids you feed your child can affect what comes out at the other end. The types of foods or liquids your child consumes will affect stool size, colour, consistency and frequency of bowel movements.

If you are concerned about your child’s bowel movement, there is one thing you should know: Everything starts in the gut.

The gut is where every child’s well-being begins. When he passes stools regularly and feels good inside, it shows on the outside.

The condition of your child’s gut may also affect his sleep, energy levels, behaviour, ability to concentrate and overall well-being.

Of course, parents hope they don’t have to cope with a child who is experiencing gut discomforts such as straining, hard stools or difficulty in moving bowels. So improve your child’s gut health by ensuring that he has a healthy and nutritious diet.

GOOD NUTRITION

Feeding a child may be one of your most important tasks as a parent.

Healthy and nutritious food will allow a child to meet the daily nutrient requirements needed for growth and development during the growing years and ensure good health later in life.

A balanced and nutritious diet should comprise a wide variety of food groups, such as rice, bread, cereals and tubers, fish, meat, poultry and legumes, fruit and vegetables as well as milk and dairy products.

For gut health and to prevent constipation, offer children foods that are rich in fibre, such as fruit and vegetables. Give fruit and vegetables daily — one cannot be substituted for the other as nutrient contents are different. Children below 7 years should be offered two servings of vegetables and two servings of fruit every day.

The gut plays an important role in other areas of a child’s health, such as ensuring the proper absorption of nutrients and supporting a healthy immune system. A poor immune system can make a child susceptible to diarrhoea and infections, which can lead to appetite loss, decrease in nutrients intake, malabsorption and eventually, under-nutrition. If a child is under-nourished, it can affect his cognitive development, behaviour and performance in school.

This is why a healthy gut is important to ensure nutrients from food are effectively absorbed.

GOOD BACTERIA

The human gut is home to trillions of microorganisms. Research shows that the number of microbial cells in a human body is 10 times more than human cells.

There are two types of bacteria in the gut. Beneficial bacteria help the gut regulate immunity and protect your child from infections.

One way to ensure your child has more beneficial than harmful bacteria is to offer a diet rich in prebiotics.

Prebiotics is a special type of insoluble fibre that acts as food source for beneficial or good bacteria naturally present in the gut.

They help stimulate the growth and multiplying of good bacteria which will suppress the growth of harmful bacteria. The increased number of good bacteria also supports a healthy gut environment, which in turn helps soften stool and promote better bowel movement.

Prebiotics, including galacto-oligosaccharides (GOS) and long-chain fructo-oligosaccharides (FOS), can help promote children’s gut health. The prebiotic, long-chain fructo-oligosaccharide (FOS) can be found naturally in many foods such as wheat, onion, banana and honey.

The unique mixture of GOS and FOS can increase the existing beneficial bacteria and subsequently reduce the harmful bacteria in the body. Other sources of prebiotics include apple, oatmeal, leek, asparagus, soya bean, tomato, garlic and onion.

START WITH THE GUT

When it comes overall health, taking care of a child’s gut health is just as important as maintaining the rest of the body.

A healthy gut will prevent stomach discomforts, ensuring a child’s overall well-being and happiness. For parent’s, that’s one less thing to worry about.

Don’t wait until your little one experiences gut discomfort. Take charge of his gut health today, starting with the food he eats. Ensure your child’s meal is healthy, nutritious and contains gut-friendly prebiotics.

The writer is a nutritionist and head of Nutritional Sciences

Programme at Universiti Kebangsaan Malaysia

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Drink to lower risk of kidney stones

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By Nadia Badarudin - Tuesday, 7 October 2014.

If you do not drink enough water, you are at risk of getting stones in the kidneys, bladder and gall bladder, writes Nadia Badarudin

YOU have been working several hours since morning.

You are thirsty and your lips are dry but you are too lazy to walk to the pantry for a glass of water.

Sometimes you refuse to drink because you do not want to go to the toilet frequently.

This is a common scenario.

We all know the importance of drinking plenty of water to maintain our health but we choose to ignore it.

Not drinking enough water means you are simply asking for trouble.

Your body will be prone to numerous health problems, including stones in kidneys, bladder or gall bladder which can cause e x c r u c i a t i n g pain.

UROLITHIASIS Pantai Hospital Kuala Lumpur consultant urologist Dr S.

Ambikai Balan says a kidney stone is a solid mass f o r m e d f r o m dietary minerals in the urine.

“The stones a re identified based on their locations in the body.

For instance, stones formed in the kidney are called kidney stones, while bladder stones are those found in the bladder.

Ureteral stones are those which originate in the kidney and get stuck in the ureter.” He says the types of stones can be ascertained from their mineral compounds.

The common types are calcium-oxalate (most common), struvite, uric acid and cystine.

Dr Balan says stone formation is related to decreased urine volume which happens because of insufficient water consumption.

“The stone is formed in a process called urolithiasis that makes the urine become supersaturated.

Urine will become crystallised, and eventually stones are formed,” he says.

Small stones can move down the urinary tract and be flushed out of the body.

However, some get stuck in the ureter and block urine flow.

“This is when the problem starts.

Some stones are so big they can only be removed surgically,” he says.

SEVERE PAIN Dr Balan says kidney stones can cause severe pain.

Some patients describe it “as bad as labour pain”.

The pain is sudden and intense.

Patients will experience a dull aching pain from the back, which moves toward the groin.

Dr Balan says the pain is unlike a urinary tract infection where patients experience a severe burning sensation while urinating and which can be eased with painkillers.

“Some patients say the pain is like somebody breaking your bone.

Some have even confused it with a heart attack.

There are also patients who collapse because of the unbearable pain,” he says.

“Sometimes, the stones are big but do not cause any pain.

They can be detected during a routine health screening or if blood is found in the urine.” AT RISK People who do not drink enough fluids (less than 1,200ml a day) a nd who a re constantly in a hot environment are at risk of having kidney stones.

“ P e o p l e living within a specific climate and geographic location (with similar dietary habits) are prone to the disease.

Other factors are family history of stone disease, a diet high in salt, calcium and animal protein, infection in the urinary system and chronic obstruction to urinary flow,” says Dr Balan, adding that patients with uncontrolled diabetes are also susceptible.

He says men are more likely to get stones than women.

“Female hormones may help prevent the formation of calcium-oxalate stones by keeping urine alkaline and by raising protective citrate levels,” he says.

“Recurrence rates are high.

Patients have a 10 per cent chance of getting the condition again if they do not change their diet and lifestyles.” Can it be fatal? Kidney stones per se do not cause death, but the consequences of having stones might have severe impact on health.

Dr Balan explains: “Stones can cause infection due to the obstruction.

This can cause severe sepsis (urosepsis) in the elderly or individualswithanimpairedimmune system.

This is life-threatening.

The renal function can deteriorate due to the obstruction, leading to renal failure in the long run.” TREATMENTS Treatment options vary, based on the size of stone, its location and whether it causes an obstruction.

The general condition of the patient also plays a big role when considering treatment options.

Dr Balan says while acute cases with obstruction require surgery, most kidney stones are managed conservatively.

The patient is advised to drink plenty of liquids.

Fresh, citrus drinks sometimes help dissolve certain types of stones.

However, prevention is always better than cure.

Dr Balan advises: “Drink water regularly and maintain a healthy diet to avoid kidney stones.

If you think you are at risk of developing urinary tract stones, it is best to talk to your doctor.

If you have suffered with stones previously, it is important to have some radiological follow-up to monitor the condition.

“Besides pain, one has to be mindful of other symptoms such as fever, chills, or loss of appetite which may indicate a more serious problem.”

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Kidney disease and diet

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BY MEERA MURUGESAN - 14 OCTOBER 2014

A diet low in salt, sugar and saturated fat can help delay kidney damage, writes Meera Murugesan

EATING habits are like a second skin and the most challenging lifestyle habit to shed.

We develop a taste for certain foods in childhood and it becomes a hurdle to change those habits as adults, even when we know they are unhealthy.

Many of us procrastinate and rarely take steps to address our eating patterns. But isn’t it better to change before we are forced to do so?

TACKLING THE TONGUE

If you like salty food, you’re probably reaching for the salt shaker without even being aware of it or pouring ketchup on your food before tasting it.

If deep-fried food is your weakness, you’re likely to find meals prepared in any other way unappealing no matter how well-flavoured they are.

Foods high in salt, sugar and saturated fats are the biggest stumbling blocks. Not only do we consume such food when eating out but such items also find their way into our kitchen cupboards.

The end result is rising levels of diabetes and hypertension in the country — two leading causes of chronic kidney disease (CKD).

CKD is present in about 10 per cent of the adult population worldwide and is a major public health hazard, says Professor Dr Joel Kopple, professor of medicine and public health at the David Geffen School of Medicine UCLA and UCLA School of Public Health in Los Angeles.

Globally, more than 500 million individuals or one in 10 adults has some form of CKD. In Malaysia, about 50-60 per cent of CKD cases are due to diabetes and hypertension.

Kidney disease impairs the kidney’s ability to eliminate bodily waste which then remains in the system and can reach fatal toxic levels.

If left untreated, CKD can cause total kidney failure and patients have to go on dialysis to stay alive.

Even with this, patients are 20 times more likely to succumb to heart attacks, heart disease and stroke. More than four million Malaysians are at risk of chronic kidney failure.

Do we really want to wait till it’s too late before attempting a change in our eating habits?

EATING RIGHT

The problem today is not only what people are eating but that they are eating way too much of everything, says Dr Maria Chan, senior renal dietitian at the faculty of medicine, University of New South Wales, Australia.

She explains that, like many other developing countries, Malaysia is becoming more affluent and people have money in their pockets to enjoy good food. We no longer eat just for nourishment or to overcome hunger. Eating is now a form of relaxation.

The downside is that people eat way too much, way too often and look for taste rather than nutritional content. When this is coupled with physical inactivity, obesity rates bloom and non-communicable diseases flourish.

But Chan says, change must happen, even if it happens gradually. And we should start in our kitchens.

AVOID OVER FLAVOURING

Use less salt when preparing meals and gradually, our tongues will become used to the natural flavours of food.

Add fresh herbs and spices, lemon juice or even home-made broth to enhance the flavour of dishes instead of reaching for bottled sauces.

“There is no one particular food that’s good or protective for the kidney. Rather, it’s our whole eating pattern that plays a key role,” says Chan.

While it’s not wrong to add traditional flavouring agents such as soya sauce or fish sauce in our food, we should be careful of how much and how often we use these.

PICK WISELY

When purchasing canned or packaged food, it’s important to read and understand the labelling in order to avoid those high in saturated fat, sugar and salt.

Chan says canned food is convenient and we do need it in our busy lives today but it’s important to choose wisely.

For example, a can of baked beans is high in fibre and good for the body but ensure that the salt content in it is not high. Similarly, canned lentils are a good source of protein and can be used in a variety of ways to make different healthy meals and canned tuna is a good accompaniment for rice or noodles.

However, instant noodles are often high in salt and saturated fat, so these are not a wise choice as regular meals.

Chan says when buying canned or pre-packed food, consumers should look for labels that clearly state “no added salt”. This means there is no additional salt added to the product. It only contains the natural sodium in ingredients.

On the other hand if a product label says “salt reduced”, it’s not necessarily a good thing. “Salt reduced can mean reduced from a very high level, so it’s still really bad. It’s a term that can be quite misleading,” she adds.

Dr Kopple says many people in Asian countries may be getting more sodium than needed because of the frequent use of flavouring agents during meal preparations.

“Years ago, the highest prevalence of hypertension was in the northern islands of Japan because they loved soya sauce but the Japanese government embarked on a long progressive campaign to lower sodium intake and it is working.”

WESTERN WOES

Another problem in developing countries is that growing affluence means people consume a Western diet more regularly. This has contributed to obesity, another risk factor for CKD.

Chan says the traditional Asian diet is a good example of a healthy balanced meal with carbohydrate- based foods like noodles and rice, some of which are also high in fibre and plenty of fruit and vegetables.

Protein is usually a medium-sized serving to complement the rice, fruit and vegetables.

However, today, more Asians are eating large chunks of salty, fatty meat. Meat is no longer a complement but the main portion of the meal like in a western diet while fruit and vegetables have been significantly reduced.

Dr Kopple agrees. He says in America, obesity and diabetes was at one time extremely uncommon among the native American Indians in New Mexico and Arizona but today it’s a raging epidemic.

This happened because not only did they switch to a Western diet when they became affluent but they also stopped their traditional daily activities which required physical movement.

“It’s a situation that’s killing them, not to mention what it’s doing to the quality of their life,” says Dr Kopple, adding that while many people with CKD do progress to end stage kidney failure and eventually require dialysis, most people don’t.

They actually die much earlier from other causes, usually from various forms of heart disease. They don’t even live long enough to need to go on dialysis.

This further highlights the tragic consequences of a lifestyle that, with education and early exposure, can be prevented.

NEVER TOO LATE

WHILE making dietary changes is important for those who want to remain healthy and avoid kidney disease, it’s equally crucial for those who have already been diagnosed with the disease.

Renal dietitian Dr Maria Chan says that when a person has been diagnosed with early stage kidney deficiency, diet can play a major role in slowing down the progression of the disease.

At the onset, the kidneys may still be able to function reasonably, so a kidney-friendly diet can help slow down the advancement of the disease. This means it may take much longer for patients to get to the stage where they will need dialysis.

“There is actually a long gap between the onset of the disease to the time they may actually need dialysis, so intervention can take place during this stage, “ says Chan.

EATING HEALTHY

When kidneys can no longer do their job, patients have to control the type and amount of food that they consume.

The National Kidney Foundation Malaysia recommends that patients work with a dietitian to come up with a daily eating plan which meets their nutritional needs, cut down the workload of the kidneys and control the build-up of food waste.

The diet should also reduce symptoms patients may face such as fatigue, nausea, itching and a bad taste in the mouth. It should also control the effects of high blood sugar if the patient is diabetic.

However, each person has different needs, depending on their age, medical history and kidney function. A dietitian will work with the patient to design an individual daily eating plan that’s right for him.

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