So why does the United States, Japan, Germany, Italy and Brazil have the highest percentage of people with failed kidneys? Last post, I shared a statistical study showing that these five countries had the largest portions of their population connected to a dialysis machine, walking around with a peritoneal catheter coming out of their belly or someone else’s kidneys inserted into their back.
I’m assuming it’s just as likely that different causes (or combinations thereof) may explain the prevalence of end-stage renal failure in each country. Nonetheless, there are probably overlapping factors. I asked the plumber who originally pointed out to me the large amount of Germans with kidney failure, what he thought was causing it. Keep in mind, he’s a plumber, not a biologist. Nonetheless, without hesitation he said, “Too much beer.” And this was coming from a man who often wears a T-shirt sporting the words “BEER POLICE.”
I then asked a friend of mine (who has T1D) who moved to Germany with his German wife what he thought. His reply: “It’s gotta be the alcohol. My first years here I was actually shocked from the amount of beer they consume…. And it’s not just the guys. I’ve seen innocent looking housewives down half liters as if it were water. Once I was in a traditional Biergarten (outdoor pub) and asked for a small light beer to which the waiter quite bluntly replied: ‘This is a Biergarten! Minimum half-a-liter my friend.’”
Another friend of mine (who is quite the British pub crawler) took a trip to Austria and Germany to visit his wife’s relatives. He referred to Austria as “Germany Lite” because he said the strength and quantity of alcohol went up several notches simply crossing the border into Germany.
So could alcohol be part of the cause? After all, alcohol has been shown, study after study (after study after study) to cause cancer (particularly breast cancer). And, of course, everybody knows it damages the liver. Why not the kidneys, too?
Italy, Germany and Brazil are known for their love of alcohol. The Italians probably drink less wine than Germans drink beer. I speak from firsthand experience, having lived in Tuscany for two years. But the actual alcohol content of Italian wine, I assume, is much stronger. And, from what a relative living in the Far East tells me, many Japanese drink an unthinkable amount of alcohol late into the night, every night (yet somehow still show up to work the next day).
At the same time, much of Africa and most of the Middle East (which have the least number of failed kidney) are populated by Muslims who do not drink alcohol for religious reasons.
Unfortunately, when I look at Wikipedia’s list of alcohol consumption per capita, neither the USA, Japan, Germany, Italy or Brazil appear in the top ten. So it’s not a very unifying theory. Germany does show up first as #23. But if alcohol consumption was the primary cause of kidney failure, then wouldn’t we expect Russia (#4) to have more dialysis units than Germany? Even Canadians (at #40) drink more than the USA (#48), Brazil (#53), Japan (#71), or Italy (#87).
Possibly, though, not drinking alcohol may offer protection against diseases like kidney failure. In other words, alcohol may not be a direct cause but otherwise puts such a strain on the body’s detoxification systems that it can’t cleanse and repair the kidneys.
“When alcohol dehydrates the body, the drying effect can affect the normal function of cells and organs, including the kidneys,” says the National Kidney Foundation. “Heavy drinking on a regular basis has been found to double the risk for kidney disease.”
They define “heavy drinking” as anything more than seven 12oz (350ml) beers per week for women, fourteen per week for men. Though, they recommend half that amount; while saying many people do not have the health (particularly anyone over 65) to be drinking any alcohol at all. Recommending a known carcinogen with such an odd sliding scale makes you wonder how much “Big Booze” influenced their advice.
The National Kidney Foundation also states that “people who drink too much are more likely to have high blood pressure.” And high blood pressure is considered to be the primary cause for burnt-out kidneys. “High blood pressure can injure both the blood vessels in and leading to your kidneys,” says the Mayo Clinic, “causing several types of kidney disease (nephropathy). ”
A risk multiplier, however, might be the medication prescribed to lower blood pressure. Oddly enough, a very common side effect of blood pressure medication is kidney damage. “ACE inhibitors and ARAs are recognised as a potential risk factor for AKI in some patients,” according to NHS Choices (“the UK’s biggest health website”).
“BP meds here (as in Italy) are considered completely harmless by most doctors and are prescribed with ease,” says my friend in Germany. “When my diabetician put me on Candesartan she made it seem like an unavoidable consequence of my diabetic condition that sooner or later I would have to accept. She didn’t even ask me about my salt or caffeine consumption because the idea is… as a diabetic life is hard enough without renouncing anything that ‘normal’ people eat.”
Yes, much better to be forced to renounce a toe, eyesight or two kidneys than give up alcohol, salt or espresso..
It’s hard to make any solid conclusions from this data. Nonetheless, I think it’s safe to look to the example of the countries with the lowest rates of kidney failure:
- Less protein- and fat-rich meals.
- Less access to junk food.
- Less time inside.
- Less inactivity.
- Less alcohol (or none at all).
- Less access to medication.
The lack of medical treatment for high blood pressure could indeed explain the lesser incidence of kidney failure in poorer countries… but at a high price. “Death rates [from heart failure] in India and Africa were three to four times higher than those documented in Western countries,” according to the European Society of Cardiology.
I don’t know about you, but I’d rather not trade one disease for another. As I’ve written about previously, despite end-stage renal failure and T1D, my wife Nicole has been able to maintain an average blood pressure of 100/60 (without any medication) using simple lifestyle and dietary changes. And, no, she doesn’t drink any alcohol.
Thinking outside the T1D matrix,
– John C. A. Manley
P.S. I can vouch that Nicole’s renal failure was not caused by alcohol consumption. I’ve never seen her touch a drop in the 16 years we’ve known each other. A more likely cause is the mouthful of mercury fillings, root canals and other toxic dental work she’s received over the last forty years. We’re hoping a total dental revision will enable her to make a big step forward in recovering enough kidney function to get off dialysis. You can help by making a donation (of any size) towards this experimental surgery at kidneykarma.com.