Gum Arabic and Kidney Failure

Gum Arabic and Kidney Failure:
An Exceptional Panacea
21
Isam Mohamed Abu Zeid*, Abdul Rahman FarajAllah**
*King Abdulaziz University, Jeddah, Saudi Arabia; **Batterjee Medical College
for Science & Technology, Jeddah, Kingdom of Saudi Arabia
Introduction
The poor savannah belt is the expanse of virtual nothingness of a huge land that
extends from the Atlantic Ocean through the middle west of Africa until it reaches
Sudan. The belt is situated in the south of the African Sahara Desert; it has already
been depicted as the most harsh, dreadful, and inhospitable domain, characterized by
nonabiding, sparse vegetation. Also, due to the ensuing unpredictable climate change,
there has been an unprecedented, unrecorded encroachment of desertification in this
poor savannah belt, which is further extended through the southern extremity in an
eastward direction of the desert fringes and has led to an imbalance of life processes.
Therefore, as a result of this, all life processes of biota (plants and animals, including
human beings) have paid a heavy price and a great toll that exceeded beyond the limits of their tolerance and, even worse, is continually shattering whole aspects of life.
Pessimistically and tragically, the worst is yet to come.
Nevertheless, with all these constraints, man is able to survive and to overcome
these unsurmountable hurdles, but these unacceptable conditions, combined withinhospitable situations, yet the fundamentals of life need to thrive, and successfully life
progresses toward ticking once more.
Gum Arabic (GA), or acacia gum (AG), is obtained from the acacia trees that grow
in this region from Senegal to Sudan, where these hardy bushes and trees are able to
withstand and tolerate all the harsh vagaries of weather. They produce a precious commodity that oozes out from these heavy, thorny shrubs and trees. Their sticky material
exudates/flows out very slowly and has become the mainstay and the bloodline for
most of the inhabitants of this region.
The precious GA produced by these trees becomes the most highly valued commodity, and its demand worldwide is never ebbed and considered a desert prize, which
brings lots of opportunities and happiness to those savannah inhabitants. With the
importance of this commodity worldwide and with is inherent versatility, many initiatives have been tried to preserve and protect those trees, including the Great Green
Wall Initiative (GGWI) during the year 2007, as a pan-African effort to battle desertification, heal and tackle poverty, and blast land degradation across the Sahel–Saharan
region of the continent.
The monumental steps to achieve the GGWI in the dire quest for alleviating
constraints have, to some degree, restored the degraded ecosystems and improved
rural livelihoods while helping to shake the encroachment of the Sahara Desert by
Gum Arabic. http://dx.doi.org/10.1016/B978-0-12-812002-6.00021-X
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addressing the ecological and socioeconomic vulnerability of the disadvantaged rural populations. It is of great urgency to put emphasis on the adoption of sustainable
landscape management techniques so as to give a helping hand to Mother Nature.
Also, GA provided a socioeconomic forum and a great potential because Acacia has
high drought resistance and is deeply rooted in the history, culture, and heritage of the
region since the onset of exporting GA to Europe, beginning back in the 17th century.
Gum Arabic as a global commodity
The global demand for GA as a precious international commodity is never matched
with any other comparable commodity, while it keeps its own specific heritage, traditions, and rituals. Based on the valuable versatility of its ingredients, it is utilized to an
unimaginable extent as foods, in pharmaceutical industries, as stabilizer in beverages,
medicine, writing, learning, confectionery, printmaking, cosmetics, industrial applications, textiles, paintings, arts, ceramics, photography, pyrotechnics, smoking and as
an emulsifier.
The procedure of obtaining the gum after mechanical injury of the trees by incision
of the bark involves removing sections of the bark with a sharp tool like an axe with
great care taken not to damage the trees. Again, GA is also obtained by removal of
branches to cover systematic wounds on the bark of trees, which prevents attack by
insects or microorganisms, and also after invasion by bacteria to shape hard modules
that are picked by hand and put away, as indicated by their color and size. Based on
information reported by, GA is defined by the Food and Agriculture Organization
(FAO)/World Health Organization Joint Expert Committee on Food Additives as a
dried exudation obtained from the stems of Acacia senegal (L.) or closely related
species of Acacia (FAO, 1999). The prime physical characteristics of GA on which
related the quantitative and qualitative parameters were based to include moisture content, total ash, volatile matter, and internal energy, which were the exact international
specifications proposed by FAO.
Health benefits and welcome scenarios of gum Arabic
GA is a polysaccharide with branched chains of (21, 22 and 23) linked
β-d-galactopyranosyl units. GA is rich in calcium, potassium, and magnesium. It is
actually produced from the stems and branches of A. senegal. It is digested in the
colon by microorganisms to short-chain fatty acids (SCFAs); therefore, it is reported
as one of the safest dietary fibers and hence has been an important food additive (Ali
et al., 2003). The supplementation of the eating routine with GA has been appeared
to increase high nitrogen discharge and lower serum urea nitrogen concentration in
patients with constant renal failure. The data from Polonsky (2012) demonstrated that
dietary supplementation with GA lowers serum butyrate, which has good impact on
renal profibrotic cytokine generation (Bliss et al., 1996).
Gum Arabic and Kidney Failure: An Exceptional Panacea
247
Prior reviews have yielded confirmations for and against the antioxidant impact
of GA and the defensive impacts in trials of hepatic, renal, and cardiovascular danger
(Ali et al., 2009). GA has appeared to lessen blood pressure, plasma cholesterol focuses in rats, to foster dental remineralization, to show that it can make an environment
hostile to microbial movement, and to animate intestinal assimilation, in this manner
preventing diarrhea (Al Mosawi, 2002; Ibrahim et al., 2004; Nasir et al., 2008). Current trials have shown that the extra-renal impacts of GA application in mice reduced
expression of intestinal sodium coupled with a glucose carrier with subsequent delay
of intestinal glucose transport, glucose-induced hyperglycemia, hyperinsulinemia, and
body weight gain (Nasir, 2013). Soluble fibers are effective in reducing cholesterol by
reducing the absorption of fats and cholesterol from the small intestine and absorption
of bile acids from the terminal ileum (Younes et al., 1995). Finally, renal function was
also improved after GA supplementation with a clear reduction in blood urea nitrogen
(BUN) and creatinine concentration in diabetics and diabetic nephropathy patients.
All patients under the investigation have recorded an overall health improvement;
therefore, this study has revealed that GA supplementation has effects on type 2 diabetes mellitus patients and has impaired the prognosis of the disease (Nasir et al., 2016).
Since a long time ago, AG has had medical values and has been used to treat a variety of illnesses, including bleeding, respiratory tract infections, and pain. Due to the
availability of a rich, soluble fiber in AG, it improves the patient's digestive system,
reduces the risk of constipation, and improves appetite, where for kidney disease patients, it helps them to get enough energy from their food. This eventually strengthens
their bodies and enhances immunity, an added parameter that better aids in a fight
against kidney problems. Moreover, unfortunately, kidney patients are subjected to
some common complications, including headaches and leg and back pains; hence for
remedy, physicians prescribe the use of painkillers, which adversely induce side effects on the diseased kidneys. A new cure is heralded by using AG as a natural painkiller that is used to ease pain in kidney disease patients.
AG is used to support a low-protein diet in children with end-stage renal disease
(ESRD), where most die without renal replacement therapy (RRT). AlKhodor and
Shatat investigated the possibility of using AG supplementation to improve the quality of life and give a sigh of relief for children with ERSD with a dialysis-free period.
Their results showed that the supplementation with AG could be a contrasting option
to renal replacement therapy (RRT) to enhance the personal satisfaction and decrease
or wipe out the requirement for dialysis in kids with end organize renal sickness.
Other studies conducted on the impact of AG on oxidative stress and aggravation in
adenine-prompted perpetual renal disappointment were considered by Badreldin et al.,
focusing on the inflammation and oxidative anxiety that was known to be required in
the pathogenesis of interminable kidney infection in people as ceaseless renal failure
in rats. They found that adenine essentially expanded the convergence of urea and creatinine in plasma, altogether diminished the creatinine clearance, and actuated critical
increments in the concentration of the measured inflammatory mediators. In addition,
it brought on oxidative stress and DNA damage, but the treatment with GA fundamentally improved these activities. Consequently, the system of detailed salutary impact
of GA in adenine-incited CRF is related to the moderation of the adenine-initiated
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inflammation and the generation of free radicals. The bidirectional relationships in
the alteration of the human microbiome affect the kidney disease progression, and
how kidney disease may disrupt a balanced microfilm has been reported by AlKhodor
and Shatat. This is due to the fact that the human body contains a combined group of
microorganisms of both prokaryotic and eukaryotic microbes that occupy intuitive interfaces presented or associated with the outer condition (Hamady and Knight, 2009).
Moreover, it was reported that these trillions of microbial cells called human microbiota and the genes encoding these microbes collectively from the human microbiome
all represent an integral part of the human genetic landscape, based on information
reported by Solt et al. The knowledge of the microbial communities colonizing various human niches was advanced by recent research work by Kuczynski et al. (2012);
however, the ecological communities of microbial species exist in symbiotic mutualistic relationship with the human host, though it might be unique to each person (Cho
and Blaser, 2012). The abundance and diversity of microbial communities are almost
individual-specific (Morgan et al., 2013), albeit much of the interpersonal diversity
was attributed to a variety of differences, including host genetics, geographical origin,
location, age, lifestyle, eating habits, early microbial exposure as well as antibiotic
and probiotic intake. Moreover, a major plethora of other factors has been reported to
contribute to the basic microbial diversity, such as mode of birth delivery, gestational
age, hospitalization, diet, and nature of feeding (Johnson and Versalovic, 2012).
Chronic kidney disease (CKD) has become a global health epidemic associated
with the grave loss of kidney functions, cardiovascular diseases, infectious diseases,
and awful premature death (Levey et al., 2005).The loss of kidney function in CKD
has resulted in major alternations in the blood concentration of numerous molecules,
especially the substances that are normally excreted or metabolized by the kidney
and accumulate as renal function declines, resulting in increased blood concentrations
(Meyer and Hostetter, 2007). These uremic retention molecules (URM) constitute an
expanding list of substances that, upon accumulation, substantially contribute to the
uremic syndrome; however, it is increasingly recognized that intestinal microbial metabolism also contributes to the generation of numerous URMs (Wikoff et al., 2009).
Kidney disease is associated with decreased consumption of dietary fibers, frequent use of antibiotics, slow colonic transit, metabolic acidosis, volume overload
with intestinal wall congestion, intestinal wall edema, and oral iron intake (Fouque
et al., 2014; Jakobsson et al., 2010; Kalantar-Zadeh et al., 2002; Nakao, 2012).
Therefore, targeting the large intestine and understanding the composition of the gut
microbial community might be a promising approach to tackle the high morbidity and
mortality in patients with CKD.
The very unique properties of GA have been researched and reported recently by
a huge number of scientists and research facilities, proving that it is a branched-chain
complex polysaccharide, either neutral or slightly acidic, found as mixed calcium,
magnesium, and potassium salt of a polysaccharidic acid. It has a variety of uses in
industry as a stabilizer, thickening agent, and an emulsifier, mainly in the food industry, i.e., in soft drinks, syrup, gummy candies, and marshmallows, but also in textile,
pottery, lithography, cosmetics, and pharmaceutical industries (Verbeken et al., 2003).
In folk medicine, it has been reported to be used internally for the treatment of
Gum Arabic and Kidney Failure: An Exceptional Panacea
249
inflammation of the intestinal mucosa and externally to cover inflamed surfaces
(Gamal el-din et al., 2003). More experiments have been conducted on GA to show its
ability to be used as a vehicle for drugs, especially in these studies about physiological and pharmacological reactions with the assumption that it is an inert substance.
Moreover, recent studies have claimed that GA possesses antioxidant, nephroprotective, and other valuable beneficial effects, especially those that go along with kidney
problems (Ali et al., 2008; Rehman et al., 2001). With the widespread occurrence of
kidney ailments, clinical studies have been conducted on patients with chronic renal
failure and have claimed to reduce urea and creatinine plasma concentrations; however, it might reduce the need for dialysis from three to two times weekly (Suliman
et al., 2000).
As it is well-documented that GA is primarily indigestible to both humans and
animals, however, it is not degraded in the small intestine, but fermented in the
large intestine by microorganisms’ SCFAs, specifically propionic acid (Kishimoto
et al., 2006; Phillips, 1998). Those degraded products are absorbed by the human colon and subsequently utilized energetically in the metabolism. More work conducted
by Kishimoto et al. (2006) showed that a Prevotella ruminicola–like bacterium was
the predominant organism that was most likely to be responsible for the fermentation
of GA.
Panacea of gum Arabic: The medical
dimensions of gum Arabic
The usual medical intervention by using dietary fiber in protecting against any disease
incidence or curing an already attacked person was adopted and practiced in the past
100 years. This is because a high intake of dietary fiber has been associated with numerous health benefits. It has been shown that a high intake of fiber from cereals and
high consumption of whole grain foods are significantly associated with a reduced
risk of colorectal cancer (Aune et al., 2011).
Many varied observations were reported suggesting that high-fiber diets may offer
protection from the risk of cancers beyond the colon (La Vecchia et al., 2003). Other
suggestions gave supportive evidence of the effect of whole-grain foods on cardiovascular disease (Truswell, 2002) and myocardial infarction (Rimm et al., 1996). Also,
the consumption of whole grains and the risk of type 2 diabetes with added observational studies led to an inverse association between fiber intake and occurrence
of type 2 diabetes, and suggested a role of added fiber intake and occurrence of type
2 diabetes associated with lower incidence of obesity (Cho et al., 2013). The more
welcome news was reported by Krishnamurthy et al. (2012), who suggested that high
dietary fiber intake provided clinical benefits for chronic disease patients. Such promising news has given a sigh of relief for patients and for the health community, where
chronic renal diseases have become an expensive asset that are growing by the day,
where the current estimates of incidence reached 10% of the population with impaired
renal dysfunction (Coresh et al., 2007).
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Manipulated dietary fiber
The heated debate about the definition of the dietary fiber ran simultaneously into its
effect and related to chemical or physiological category or function of the fiber itself.
The internationally acceptable definition in 2009 was adopted and reported by Phillips
and Cui (2011). Dietary fiber means carbohydrate polymers with 10 or more monomeric units that are not hydrolyzed by the endogenous enzymes in the small intestine of
humans. They may belong to the following categories: either edible carbohydrate polymers naturally occurring in the consumed food, or carbohydrate polymers obtained from
raw material by physiological or chemical means. These might reflect physiological
effects or be beneficial to health demonstrated by accepted scientific evidence to competent authorities or synthetic carbohydrate polymers that did show physiological effect
(Cummings and Stephen, 2007). The outcome of the debate relied on the conversion in
the colon to SCFAs, which is a necessary requirement if the material is to be accepted
as a dietary fibrosis. But to make a health claim needed critical characterization in the
chemical, biological, physiological, and clinical domains. Therefore, while the general
identification of dietary fiber can be made on a chemical basis, any specific health claim
must be based upon its physiological and clinical performance (Phillips, 2013).
Dietary fiber and renal disease
Currently the dietary advice for chronic kidney disease (CKD) is the intake of salt,
phosphate potassium, and protein, which showed that dietary fiber is well-defined,
where fruits and vegetables often restricted in CKD to prevent or correct hyperkalemia are an important source of dietary fiber. A recent landmark study has energized
the interest in using the Third National Health and Nutritional Examination Survey
(NHANES III), a database that identified a positive association between fiber intake
and mortality in patients with kidney disease (Krishnamurthy et al., 2012).
Recent investigations have suggested reducing of the load of colon-derived solutes,
which was postulated to be a potential therapeutic option in CKD in order to delay the
progression of renal disease and also to reduce the associated cardiovascular morbidity and fatalities. One of the promising approaches was to administer sorbents that
bind to microbial metabolites. Evidences have been accumulated that carbon-based
sorbent AST-120 may reduce circulating levels of inxodyl sulfate and ameliorate decline in renal function (Lida et al., 2006; Nakamura et al., 2011; Owada et al., 2010;
Ueda et al., 2007, 2008). This reduces the intestinal absorption to tryptophan-derived
indoles, which subsequently reduce the hepatic conversion of indoles to indoxyl sulfate. Dietary fiber is postulated to provide health benefits through the production of
SCFAs and a product fiber of fermentation, since SCFAs are known to have numerous
biologically important effects, including modulation of cell proliferation, apoptosis,
and regulation of angiogenesis and inflammation (Smith et al., 1998).
The effect of SCFAs was linked with the improvement of both colonic and systemic
health. Also, other studies of the pathogenesis of the progression of renal fibrosis suggest
that SCFAs have antifibrotic activities in reducing the generation of biological activity of
Gum Arabic and Kidney Failure: An Exceptional Panacea
251
the key profibrotic cytokine transforming growth factor beta 1 (Matsumoto et al., 2006).
The amount and type of SCFAs formed by colonic bacteria depend on the chemical structure, composition, and the amount of the available substrate. This has important implications, such as health benefit claims cannot be assumed to be generic for all types of fiber.
One spectacular dietary fiber that has generated an interest in the context of CKD is GA.
Gum Arabic (Acacia senegal ) as a source
of useful dietary fiber
GA has been in the scientific community worldwide because of successful trials and
cures for kidney disease patients, even at the end stage. In reality, GA is an edible
tree gum exudate that has a multitude of uses as a stabilizer, thickening agent, and an
emulsifier, mainly in the food industry; however, it has a lot of benefits in the food
industry, in addition to textile, pottery, cosmetics, and pharmaceutical industries. It
has been extensively tested for its properties as nondigestible polysaccharides. GA
has been shown to conform with the definition of dietary fiber adopted by Codex as a
nonstarch polysaccharide, since GA is not digested in the intestine, but is fermented
in the colon to give SCFAs, leading to a wide range of potential health benefits. The
overall definition of GA allows for the two tree species, A. senegal and Acacia seyal.
Based on its growth in a wide geographical region all over the Sahelian belt of Africa,
the commercial product can show extremely wide chemical and physical variability
(Idris et al., 1998; Mocak et al., 1998).
Based on its physical properties, it retards glucose absorption, increases stool mass,
traps bile acids, and has a potential to beneficially modify the physiological status of
human subjects (Adiotomre et al., 1990; Annison et al., 1995). The GA reaches the
large intestine undigested in the small intestine. Therefore, it is categorized as a nondigestible carbohydrate or dietary fiber. However, it is fermented by intestinal bacteria
to SCFAs in the large intestine (Annison et al., 1995; May et al., 1994). It has also been
shown to be bifidogenic dietary fiber (Cherbut et al., 2003; Michel et al., 1998). They
also reported that it has been too easy and selectively raised the proportions of lactic
acid bacteria and Bifidobacteria in healthy subjects. It is fermented slowly; hence, it
produces SCFAs, and the fecal digestibility is almost 95%; however, it increases stool
output by augmenting the water content of stools. It has a real intestinal tolerance with
high dietary doses that can be consumed without any adverse intestinal events. All the
mentioned properties would support a potential role for dietary supplementation with
Arabic gum in renal diseases by changing the proteolytic to saccharolytic fermentation pattern of colonic bacteria.
Gum Arabic and renal function
Currently, many research works have been carried over in so many multitudes of
rational parameters in equating the credibility and significance of GA with the objectives of its critical validity in the remedy and amelioration of kidney dysfunction and
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end-stage kidney failure. Those promising aspects have been based on its chemistry, chemical composition, degradation in the small intestine (Al-Assaf et al., 2005;
Kishimoto et al., 2006), and its pharmacological properties as an antioxidant (Ali and
Al Moundhri, 2006), and more recently, Al-Assaf et al. (2005) reported that GA was
ineffective in ameliorating hepatocellular damage in cholestasis induced by fenofibrate in rats. The effect of GA on renal function has been tackled by many scientists
on patients with end-stage renal failure (ESRF) disease that requires renal replacement therapy (RRT) in the form of either dialysis or renal transplantation for survival.
The ESRF patients requiring RRT have increased dramatically throughout the world
during the last decade (Locatelli et al., 2006); hence the cost of treating uremia represents a growing demand on the health-care systems of both rich and poor people.
Most dietary attempts to treat chronic renal failure (CRF) and to decrease uremia use
a protein restriction regimen (Fouque et al., 2006), although Chaturvedi and Jones
(2007) recently have proposed alternative dietetic approaches and some suggestions
based on fermentable carbohydrate supplementation of the diet (Winchester and Salsburgh, 2004), which has led them to claim that these results in a similar urea-lowering
effect by increasing urea nitrogen (N) excretion in stools with a concomitant decrease
in the total N excreted in the urine of adults. Ali et al. (2008) have also reported no
explanation of many results recovered, but the inclusion of iron and folic acid supplements have not been justified, although it was concluded that GA could alleviate
“adverse effects of CRF.”
The effect of GA on blood glucose concentration is when the infusion of meals
containing starch showed that a decrease in the digestion rate of starch in the upper
small intestine accounted for part of the viscosity of glycemic response, whereas the
main effect of gum appeared to slow gastric emptying (Leclère et al., 1994). The other
major predominant investigations on the overall effects of GA on the gastrointestinal
tract were conducted by Codipilly et al. (2006), Karrasch and Jobin (2008), and Wapnir et al. (2008), and the degradation of GA in the intestine was done by Kishimoto
et al. (2006).
In addition to the effect of GA on lipid metabolism (Pasquier et al., 1996) and by
mimicking pH conditions in the stomach, and evaluating the effect of several soluble
fibers, including GA, on dietary fat emulsification and lipolysis in vitro, where it was
found that GA strongly inhibited lipolysis at pH 4.5, but without having any effect
on the emulsion droplet size. However, the inhibition was attributed to the possible
strong interaction of the protein moiety of GA with the available droplet (lipid/water)
interface (where gastric lipase acts), blocking it or preventing the release of the nonesterified fatty acid generated at the droplet surface.
Moreover, the total effect of GA on tooth mineralization, where dental caries occur
when tooth enamel is lost due to an imbalance of the demineralization and remineralization phases, if prevention can be achieved by remineralization phase is enhanced
(Aoba, 2004). Several agents have been used, including fluoride. Using histopathological methods showed that GA has the ability to enhance remineralization (Onishi
et al., 2008) or by supporting other remineralization activities may be due to rich
content of calcium, magnesium, and potassium salts of polysaccharides in GA to the
effect of the gum on the metabolism of calcium and possibly phosphate. It was also
Gum Arabic and Kidney Failure: An Exceptional Panacea
253
known that GA contains cyanogenetic glycosides and enzymes such as oxidases, peroxidases, and pectinases that inhibit antimicrobial properties against organisms such
as Prophyromonas gingivalis and Prevotella intermedia.
The effect of GA on hepatic macrophages came from earlier studies that GA is
capable of completely blocking the macrophage function (Fujiwara et al., 1995;
Mochida et al., 1990). Therefore, such effects of GA merit consideration in the
therapy of chronic liver disease as deranged from the function of Kupffer cells and
hepatic macrophages occur in this disease and is involved in its complications, such
as endotoxemia. Some extra studies were conducted on what might be adverse effects
and toxicity of GA allergy, contact dermatitis, and asthma; however, in all reports,
the offending allergen has not yet been identified. Moreover, in 1998, carbohydratespecific immunoglobulin E (IgE) was identified in a chocolate confectionery, along
with cough and dyspnea (Fötisch et al., 1998). More recently, Sander et al. (2006)
found that sensitization to GA carbohydrate structures occurs casually in atopic patients with pollen sensitization without obvious exposure to GA, and the allergy to
GA is mediated preferentially by IgE antibodies directed to polypeptide chains of
GA. The addition of 10% GA in the drinking water for either 3 or 14 days was found
to decrease urinary excretion of inorganic phosphate and increased that of calcium
and magnesium; it also decrease plasma concentration of 1,25-dihydroxyvitamin D in
healthy mice (Nasir et al., 2008).
Role of gum Arabic in renal disease
In many parts of Africa and Middle Eastern countries, it is believed that GA has
many attributes to be used in folk medicine and the cure of kidney disease. Lowering
of serum urea nitrogen was reported almost 20 years ago in a cohort of patients with
CRD. Encouraging positive results on treating renal disease was attributable work
performed over a decade in Khartoum (Sudan), suggesting beneficial effects on blood
biochemistry following dietary supplementation with 50 grams/day in patients with
CKD, predominantly under RRT (Suliman et al., 2000). More welcome news came
from central Sudan from a cohort of patients undergoing regular hemodialysis led to
an improvement of their biochemical profile (Ali et al., 2008). This news is welcomed
by needy people, as it offers a potential supplementary therapy, which, when combined with dialysis, reduces the cost burden and improves patients symptomatically
and their well-being. GA may also have a direct effect in modifying renal disease prior
to the need of RRT. Trials showed that with GA supplementation of 7.5 g/100 mL in
drinking water in a rat model of acute nephrotoxicity (gentamicin), renal decline led
to the reduction in renal injury independently of its action of fecal bacterial ammonia
metabolism (Ali et al., 2003). This direct renoprotective effect of GA is supported by
observation in models of cisplatin-induced renal injury (Al-Majed et al., 2003) and a
model of ischemic acute renal injury (Mahmoud et al., 2012). The experimental evidence in models of chronic renal injury is less clean, with the studies providing both
positive and negative findings. With two different rodent models of progressive renal
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injury, Ali et al. (2010) and Ali et al. (2004) have shown their major effect on these rodents. Previous studies on GA did not specify its species nor the molecular parameters
of the materials used. Some wide variation could be related to its geographical origin,
age of the tree, and nature of the soil (Al-Assaf et al., 2005).
Usually, a random commercial product may not be pure and could be made for
more than one species of Acacia. However, other researchers have embarked in clinical programs to evaluate the potential health benefits using characterized standardized preparations of GA, specifically A. senegal var. senegal using the same material
already described by Shao-Ping et al. (2013) This work has demonstrated that the
dietary supplementation with GA has a significant effect on blood pressure in a cohort
of patients with renal disease (Glover et al., 2009); how this may translate into alteration in renal functions in the longer term remains to be explored in depth, which has
generated fervor and energized a multitude of scientists to delve and deeply address
focusing on the ongoing clinical trials.
Herbal therapy medicine and hemodialysis
Awfully, the end-stage disease has been described as the worst kidney function; hence,
an urgent priority is the improvement of its prognosis for better thriving human life.
Tragically speaking, the ESRD is the worst condition because most kidney functions
are lost, and this is coupled with a bad prognosis for patients who are tethered to dialysis machines and characterized with low urine output. For humans, the two kidneys represent part of the bloodline for healthy life or part of the elixir of life because
both kidneys are vital motors that kick away all sorts of wastes and toxic substances.
Therefore, the loss of the kidney function or part of them represents an unmatched
predicament to a fundamentally precious human life. Most of the sufferings that emanate from anyone with a kidney disease comes from the presence of toxic substances
and excessive water buildup in the blood. Hence, the deposition of toxins contributes
to further damage to kidney cells and tissues and negates the kidney-treating medications. Currently, many of the renal experts all over the world, including Shijiazhuang
Kidney Disease Hospital in China, work in conjugation with the concerted efforts to
develop natural treatment under the banner of toxins-removing treatment. The adoption
of herbal medicine therapy for kidney disease treatment becomes rational assets with
the end result of elimination of various waste products and excessive toxic substances
due to the presence of active ingredients that can penetrate inside the affected kidney
lesions directly. It is reported that GA can help slow down the progression of kidney
damage by inhibiting inflammation and oxidative stress. However, it cannot repair damaged kidney tissues, therefore GA cannot help kidney failure patients to avoid dialysis.
Hence, a sigh of relief might be achieved by recovering all kidney functions due to the
improved prognosis naturally and gradually by herbal medications (Anon., 2015b).
The vitality of the human body and the kidneys have multifactorial benefits, including the maintenance of water balance, electrolytes, hormones, regulating blood
pressure, strengthening bone, and, in certain cases, generating enough red blood cells
in hypoxic kidneys. The prime function of the kidneys is the production of urine coupled with the discharge of wasteful products of metabolism out of the body, although
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the kidneys are very fragile, easily injured, or damaged; hence the renal parenchyma, renal vasculature, damaged part, or even all of the kidney functions will be lost.
Miraculously, the kidneys are endowed with great compensatory abilities because often, kidney disease patients show no obvious symptoms until, ironically, more than
50% of the kidney function is already lost. In case the kidneys are damaged, the patients will endure and mention a few symptoms, including swelling, electrolyte abnormalities, high blood pressure, urine changes, bone problems, and anemia.
Normally, the ESRF patients are not unfamiliar with kidney transplants because
many are put on the waiting list for a donor kidney while they are on maintenance
dialysis; hence, they can easily get rid of dialysis and rebuild the kidney functions, as
successful transplant of one kidney can improve 5% of kidney functions.
Intrinsically, kidney transplant is very effective, but usually fails within the years because not every kidney patient is able to do kidney transplant. Hence, Micro-Chinese
Osmotherapy (Anon., 2016) is a reliable choice; although it takes longer time than the
kidney transplant to have curative effects, it is more natural and safer. GA cannot eliminate the need for dialysis where a better resort is Micro-Chinese medicine Osmotherapy,
which helps to repair kidney damage and helps to improve renal function. This is the
radical way to treat kidney failure and it is possible to eliminate dialysis. The active ingredients in Chinese medicine can help eliminate blood qi stasis, promote blood circulation
so as to provide adequate blood oxygen to renal tissues. Besides, Chinese medicine can
also provide many nutrients such as vitamins, essential amino acids, trace elements for
restoring injured kidney tissues. The active ingredients in the medicines have the functions of vasodilation, and they increase blood flow anticoagulation, antiinflammation,
and antidegradation of extracellular matrix (Anon., 2015a). This automatically promotes
blood circulation and increases blood flow to the kidneys and other vital organs. It also
contains many nutrients to nourish the renal tissues and can refresh damaged renal tissue
and generate new renal functioning tissues so as to gradually restore renal structure and
improve kidney functions (Anon., 2013). It is well-documented that AG can reverse part
of kidney damage, but not enough for curing kidney failure and evidently no way for
elimination of dialysis. Recent advancement in the treatment of kidney failure and the
elimination of dialysis has been offered by Micro-Chinese Osmotherapy that helps repair
kidney damage and improves renal function. The active ingredients in Chinese medicine
can help eliminate blood stasis and promote blood circulation to provide adequate blood
and oxygen to needy, hungry renal tissues. In addition to that, Chinese medicine can
provide essential nutrients such as vitamins, essential amino acids, and trace elements for
restoring injured kidney tissues. Moreover, it can promote the replication of DNA of renal
intrinsic cells so as to produce new renal functioning cells and rebuild renal functions.
Kidney failure means that the kidneys cannot work well, and people have to live
with dialysis and kidney transplants, however, dialysis is not always necessary. Still,
some patients might still have a chance to avoid dialysis. It was reported that the unique
properties in GA can help slow down the progression of kidney damage by inhibiting
inflammation and oxidative stress. Moreover, GA is known to reduce urea through utilizing the bowel as a “substitute kidney” and increasing BUN excretion in stools, but
GA cannot repair damaged kidney tissues; even though it is helpful, it cannot stop the
progression. The best treatment for kidney failure patients is in Shijizhuang Kidney
Disease Hospital in China, which, indeed, helps patients avoid dialysis with the secret
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Gum Arabic
of traditional Chinese medicine (Anon., 2015b). In the Micro-Chinese Osmotherapy,
which is a popular herbal therapy where the effective ingredients can permeate into
kidney lesions directly, which have the function of purifying the blood and increasing
blood circulation, bringing enough blood volume and oxygen to function adequately
since the kidneys were normally, patients won’t need dialysis (Anon., 2015b).
Therefore, in order to summarize all activities, it is fair to say that the potential of
GA in kidney dysfunction is very promising, but more work is needed to decipher
in active performance of this natural product with its impeccable active ingredients.
This emanates from the realization that GA is a nondigestible food ingredient that
has found many applications in the food and pharmaceutical industries. The gums are
claimed to have therapeutic usefulness in hepatic and renal failures, and this awaits
further verification in animal models and, automatically, the concern of humans. No
significant adverse or toxic actions have been associated with the use of GA, which is
a certificate and witness that has been said and documented by many human patients
who have been tied to hemodialysis from three to four times weekly.
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Further Readings
Al Mosawi, A.J., 2007. The use of acacia gum in end stage renal failure. J. Trop. Pediatr. 53,
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Dis. Sci. 48, 755–760.