A 24-year-old boy has been suffering from uremia and undergoing dialysis for ten years, just because he drank Coke instead of water?

Real points:

It is very likely that the "Coke man" had chronic nephritis or type 1 diabetes, and on this basis, he drank cola for two consecutive years, which led to uremia. It cannot be assumed that healthy people who often drink cola and other sugary drinks will develop uremia.

Verifier: Li Qing | Director of Nephrology Department, Tianjin University Teda Hospital

According to media reports, there is a dialysis patient in the hemodialysis room of Huiyang Sanhe Hospital in Guangdong Province who is known as "Coke Brother". Before he got sick, he was a construction team contractor. When he was thirsty, he drank cola instead of water, at least two or three bottles a day for two years. At the age of 24, he was diagnosed with advanced uremia and has been on dialysis for nearly 10 years.

It seems a bit shocking that one would develop uremia after drinking Coke for two years in a row. Is his uremia really caused by drinking Coke?

1. There are many causes of uremia, and it is a long process from kidney disease to uremia.

First of all, uremia is not a disease, but a common outcome of many kidney diseases. Generally speaking, no matter what the cause of kidney disease is, when blood creatinine is ≥707µmol/L, or glomerular filtration rate is <15ml/min, it is diagnosed as "end-stage renal disease", commonly known as "uremia".

There are many causes of uremia, including diseases originating in the kidneys, such as chronic glomerulonephritis; there are also diseases outside the kidneys that damage the kidneys and develop into uremia, such as diabetic nephropathy, hypertensive kidney disease, systemic lupus erythematosus nephritis, etc. Glomerulonephritis currently ranks first in my country. In summary, the common causes of uremia in my country are as follows:

1. Chronic glomerulonephritis

This is what we often call chronic nephritis, which is the main cause of disease in dialysis patients in my country. There are many types of chronic nephritis, and the most common ones in my country are IgA nephropathy and membranous nephropathy.

2. Diabetic nephropathy

If blood sugar is not effectively controlled, diabetic nephropathy will occur in about 5 years. If it continues to develop, the urine protein will increase and the blood creatinine will increase, and it will develop into uremia.

3. Hypertensive kidney disease

If blood pressure is not effectively controlled, hypertensive kidney disease will occur in about 5 to 10 years. If it continues to develop, the glomerular filtration rate will become lower and lower, and it will develop into uremia.

4. Autoimmune disease kidney damage

It can be said that all autoimmune diseases can damage the kidneys. Common autoimmune diseases that cause uremia include systemic lupus erythematosus and systemic vasculitis.

5. Polycystic kidney disease

Polycystic kidney disease is a genetic disease in which both kidneys are occupied by multiple cysts of varying sizes. The cysts grow larger and larger and eventually develop into uremia.

6. Gouty nephropathy

High blood uric acid not only causes gouty arthritis, but also leads to hyperuricemia nephropathy (gouty nephropathy). As the incidence of hyperuricemia increases, the incidence of uremia caused by gout also increases.

7. Drug-induced renal damage

Drugs that may easily cause kidney damage include antibiotics, antipyretics and analgesics, some Chinese medicines, contrast agents, etc.

Judging from the above causes, long-term drinking of cola will not directly lead to uremia. Moreover, the process from kidney disease to uremia is a relatively long one. Even if antipyretic and analgesic drugs and certain Chinese medicinal materials that are recognized as nephrotoxic are taken continuously for 2 years, most people will not develop uremia.

2. Drinking Coke will not directly lead to uremia. It is highly likely that the "Coke Brother" has other medical histories.

Generally speaking, it takes about 5 years from diabetes to diabetic nephropathy, and about 5 years from diabetic nephropathy to uremia. In other words, it takes about 10 years from the onset of diabetes to uremia. Of course, severe diabetes may develop faster, but it is impossible to develop uremia from the onset of diabetes within 2 years.

If we follow the general rule and speculate that the young man in the case simply developed uremia from diabetic nephropathy, then he should have developed diabetes in his teens, which could be type 1 diabetes. Another possibility, and it is very likely, is that he originally had chronic glomerulonephritis, and on the basis of chronic nephritis, he did not control his diet and drank a lot of beverages for a long time, which led to uremia in 2 years.

Chronic glomerulonephritis is common in children and adolescents. In the early stage, it only presents with proteinuria and hematuria, or hypertension, but there are no uncomfortable symptoms. It is difficult to detect without a physical examination, so it is often ignored. In some extreme cases, such as rapidly progressive nephritis, it may take 1 year from onset to uremia; some IgA nephropathy, if it progresses quickly, may develop into uremia within 10 years. If there are other kidney damage factors at the same time, such as hypertension, diabetes, hyperuricemia, etc., the disease may progress faster.

In other words, this "Coke man" most likely had chronic nephritis or type 1 diabetes, and on this basis, he drank cola for two consecutive years, which led to uremia. Although the report did not mention his medical history, the above is also speculation, but we cannot simply assume that cola directly caused uremia, nor can we conclude that healthy people who often drink cola or similar sugary drinks will develop uremia.

3. Coke is indeed an unhealthy drink and should be consumed less

Drinking cola for a long time will not directly lead to uremia, but drinking cola or other sugary drinks for a long time may cause obesity and increase the risk of diabetes. Obesity and overweight are the decisive factors leading to type 2 diabetes.

A report published in the American Journal of Clinical Nutrition in 2013, which surveyed 66,118 women for 14 years, showed that long-term intake of beverages containing artificial sweeteners is more likely to induce obesity and type 2 diabetes. The Canadian Dietary Guidelines (2019) also clearly require limiting the consumption of beverages containing sugar, salt, and saturated fatty acids, such as sugary drinks, alcohol, fruit juice, hot chocolate, and milk tea. The healthiest drink is boiled water. In addition, low-fat milk, plant milk (soy milk, almond milk), sugar-free coffee and tea are also considered healthy drinks.

In 2019, the Singapore Ministry of Health announced that sugary drinks such as cola are the "most unhealthy" foods and are not allowed to be advertised on television, print or the Internet. The Singapore authorities said this was the latest move in the country's ongoing "war on diabetes." In addition to the advertising ban, the Singapore Ministry of Health also announced that it would introduce graded and color-coded nutrition labels on high-sugar drinks, indicating the nutritional quality and sugar content, so that consumers can make informed choices and consciously choose healthier products.

The World Health Organization recommends that the standard daily sugar intake for normal adults is generally 40 to 50 grams, and it is best not to exceed 25 grams.

A 500ml bottle of Coke contains 53 grams of sugar. Drinking a bottle of Coke alone will exceed the daily sugar intake limit. If you add other sugary foods, the daily sugar intake seriously exceeds the body's physiological needs.

In addition to causing diabetes, long-term drinking of beverages may also induce gout.

Columbia University and Harvard Medical School conducted a 12-year follow-up survey of 46,000 men over 40 years old with no history of gout and found that those who drank 2 to 3 cans of soft drinks (i.e., non-alcoholic beverages) a day had an 85% higher risk of gout than those who consumed less than one can of drinks per month, which was more serious than the impact of alcohol. Boston Medical School in the United States also conducted a 22-year follow-up study (1984-2006), and the results showed that drinking fructose-rich beverages such as sugary soda and orange juice would increase the concentration of uric acid in the blood and increase the risk of gout in women. Women who drank one or more servings of orange juice a day had a 41% and 142% higher risk of gout, respectively.

Regardless of whether Coke is the "accomplice" of "Coke Brother"'s uremia, drinking Coke for a long time is definitely unhealthy. As for whether to drink it and how much to drink, everyone can choose for themselves.

Editor of this article: ambergchen