Ask the Experts: Diabetes and Kidney Disease
Ask the Expert: Diabetes and Kidney Disease
Revolution Health
I am a 52-year-old woman with diabetes and kidney problems. What can I do to slow or reverse the progression of my kidney disease?
First, it's always important to have an overall medical checkup to establish the exact stage of your kidney disease and address issues like kidney filtration rate, blood pressure and anemia. I would also do a full renal evaluation to exclude other possible causes, including an ultrasound that can identify anatomic abnormalities — horseshoe-shaped kidney, for example, or undiagnosed blockage in the urinary tract or kidney stones.
Once the diagnosis is clear, it's time to talk about an integrative treatment strategy, which addresses slowing the progression of kidney disease and also taking an aggressive stance against your diabetes.
In terms of your kidneys, the conventional approach of prescribing an ACE inhibitor (commonly used to treat high blood pressure) to stop the advance of chronic kidney disease remains essential, even if your blood pressure is currently normal.
You should also ask your doctor if any supplements are relevant in your particular case: Vitamin D can ease the workload on the kidneys and stop the progression of renal failure, for example. Folate has a positive effect on vascular disease (related to both diabetes and kidney problems) and coenzyme Q10 seems to have antioxidant effect and may help renal tubular regeneration. All three have no proven downside. Though still unproven, supplements L-arginine and alpha-lipoic acid may also be helpful in preventing the progression of vascular disease — always important in diabetic kidney disease.
Lifestyle changes are also key, as we know many other factors contribute to kidney disease that can't be managed by drugs. Tobacco use is a well-known contributor to the progression of kidney disease, so it's essential to quit smoking immediately. Often, the one-two punch of hypnosis and acupuncture treatments can help with quitting.
In addition, I've had a lot of success working together with Chinese medicine practitioners to manage both diabetes and related kidney problems. Chinese medicine theory describes the kidneys as the region associated with generating root chi, or constitutional energy, the energy that you were born with.
So working with a practitioner (using acupuncture and perhaps other techniques) to bring energy back to the kidney system can help improve your motivation, for one thing, and promote positive changes in behavior with regard to eating patterns and exercise.
Why is this important? Because we know that type 2 diabetes syndrome and the insulin resistance that goes with it are reversible with lifestyle modification — namely, attaining and maintaining a healthy weight — and that this, in turn, has a positive effect on kidney disease.
If people with type 2 diabetes are taking insulin (which can lead to weight gain) and they are in an early stage of kidney disease, I assess whether they can be switched to metformin, which actually induces weight loss. In addition, I recommend seeing a nutritionist to talk about diet and exercise changes you need to make in order lose weight and stay as healthy as possible — both in terms of your diabetes and kidney problems and overall well-being.
From an interview with Sylver Quevedo, M.D., M.P.H., associate professor of medicine and nephrology at the Duke Integrative Medicine Center at Duke University in Durham, N.C.
