it’s not all good

“I’m feeling good Doc,” Mr. Holly said as I sat down on my stool in the clinic exam room. He sat in the chair beside the computer table, his round freckled face beaming. “That’s great,” I smiled back. I love it when my patients feel well.

But I had seen his lab results.

Mr. Holly is in his mid-forties and has fairly advanced chronic kidney disease as a result of even worse diabetes. The diabetes had also been taking a toll on his eyes and heart, leaving him damn near blind in one eye and in need of a heart bypass surgery. He had ignored his health until 5 years ago when diabetes symptoms took center stage. But since I met him 3 years ago, he had been doing the best he knew how to improve his health—except to stop smoking or lose weight. And at least he knew his medicines, was taking them, and showed up to his appointments. Well, most of them anyway.

I last saw him in clinic 3 months ago. His kidney function was about 30% at that time, as it had been since the visit before. Stable. Not good, but at least not worse than before. But the labs drawn just a couple of days ago showed that his kidney function was down to 21%. If it dropped any further, I would need to start the dreaded, tear-inducing “What do you want to do when your kidneys fail completely?” conversation.

“What have you been up to?” I asked.

“Oh, I’ve been drinking this health drink from Costco,” he said.

Uh oh.

 “It’s called “acai berry juice” and it’s natural and it’s got all kinds of antioxidants and stuff in it.”

Acai berry. Acai berry. I searched the recesses of my mind to remember acai berry can have the same effects has NSAIDS—non-steroidal anti-inflammatory drugs, like Ibuprofen, Motrin, Aleve. Taking a lot of NSAIDS for a long period of time can cause sudden—and sometimes irreversible—worsening of kidney disease, especially in people with chronic kidney disease. And though acai berry can help patients with diabetes lower their blood sugars a little, lowering blood sugar while kidney function is getting worse can be extremely dangerous—because it is the kidneys that remove most diabetes medicines from our bodies and sick kidneys aren't so good at removing things.

“I’ve been drinking it every day for the last 2 months,” he went on, sitting up straight with his shoulders back. He was pleased with himself.

But I was worried for him.

“I want you to stop drinking it,” I said sternly. His face changed with a quizzical arch of one eyebrow and an expression reminiscent of Gary Coleman’s Different Strokes catchphrase—“What you talkin’ ‘bout, Willis?”

“You want me to stop drinking it?” he asked instead. His frame deflated like a scolded little boy who knew he had been bad.

I explained to ease his guilt that what he had done was not unusual. That most people assumed “natural” products could only do good. That because dietary supplements are considered “food” and not “drug,” the companies making them are not required to test their products for safety, to prove the benefits they claim the products have are true, or even to make sure that each batch contains the same amount of the active ingredient.

“So, yes, please stop taking it,” I said again. “And I want to check your kidney function again in 1 week.” I hoped we weren’t too late.

“OK Doctor,” he nodded.

A week later his kidney function test was back to about 30%. I exhaled in relief.

I called Mr. Holly with the good news.

“So I shouldn’t drink it anymore, huh, Doctor?” he asked and went on to tell me about how his mother, who has diabetes too, had argued with him that the acai berry juice was good for them.