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“Stop using medicine to treat your food”: perspective from a kidney specialist

By Dr. King-Wing Ma

There is a Chinese proverb that says, “Disease enters through the mouth.” Ludwig Feuerbach stated that “man is what he eats”. In the past few decades, we have witnessed a dramatic surge in obesity and type 2 diabetes. This is largely attributed to our “modern diet”, which is characterized by excessive intake of saturated fat, omega-6 fatty acids, salt, and refined sugar. According to a recent study published in the New England Journal of Medicine, there were a total of 107.7 million obese children and 603.7 million obese adults globally in 2015. The prevalence of obesity has doubled in more than 70 countries since 1980. Obesity has been shown in various studies to be a significant risk factor of cardiovascular disease, type 2 diabetes, osteoarthritis, liver and kidney disease, sleep apnea, and depression. In Hong Kong, diabetes is the leading cause of end stage kidney disease. 

I still remember vividly the first patient who was admitted to medical ward when I was an intern. Mr. Chan was a middle-aged security guard. He came to the hospital complaining of shortness of breath and leg swelling. He was morbidly obese. He had high blood pressure, type 2 diabetes, high cholesterol, and chronic kidney disease. He had protein in his urine and his kidney function was impaired. Chest X-ray showed that his lungs were filled with fluid. When I checked his medical records, he was just discharged from hospital a month ago for the same problem. Over the past 10 years, he was given increasing number of medications, but his condition kept deteriorating. Since he was readmitted to hospital shortly after discharge, I was a bit doubtful about his drug compliance. To my surprise, he took all his medications on time and almost never missed a single dose. I knew he was not lying. We treated him with the best medications available, but why did he get worse? It was all about his diet! He consumed a lot of carbohydrate and he was unaware of the hidden sugar in many food he ate. His diabetes got worse and more medications were added, some of which caused significant weight gain. A few years later, I met him again in the corridor of the hospital. He was heading to the renal unit to receive dialysis.

History repeats itself. I met many other patients like Mr. Chan in the subsequent years of my clinical practice. As a kidney specialist, I manage many patients who need dialysis. We are trained how to optimize the efficacy of dialysis and control various parameters, but we still lose many of these patients in a few years no matter what we do. In contrary, I do see some highly motivated diabetic patients who follow their dietary restrictions consistently and persistently. They have significant weight reduction and do not have any complications 10 years after diagnosis of diabetes. Some of them are able to reduce their medications after controlling their diet.

This is now accumulating evidence which suggests that type 2 diabetes is a potentially reversible disease. The key is “intensive dietary management”. When people substantially cut down their carbohydrate and sugar intake, weight reduction and improved blood sugar control will follow. In some cases, patients are able to stop all their diabetic medications. As a doctor, we always want to provide the best treatment to our patients. Perhaps in the battle against obesity and type 2 diabetes, the first thing we need to remind ourselves is to “stop using medicine to treat our food”.