Hypertension, diabetes and high cholesterol,the triple epidemics
In Ghana, we behave as if life will take care of itself and have a self-fulfilling prophesy, everything gonna be alright or if it boils, it will cool down and, therefore, we do not take proactive action(s) even against the things that do us the most damage.
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In any serious country, the entire medical establishment and the scientific world will be tearing their hairs out to find out why and how all these three non-communicable diseases have reached epidemic proportions in such a short time.
The diseases in Ghana seem to defy even the normal biological protection afforded by some hormones; in particular, the female hormones.
Standard teaching refers to the protection of oestrogens in particular in hypertension. Prior to menopause, women are protected and few of them acquire the silent killer.
The variation of hypertensive prevalence between women in the reproductive age group and their male counterparts is of the order of 1:10. One female will have hypertension for every 10 males and the females get the disease during pregnancy, which may resolve after the pregnancy or in a few cases continue. In Ghana, however, the ratio is fast approaching parity
Work done in the 1950s and 1960s by some of our greatest physicians pointed to less than 0.5 per cent prevalence of Diabetes and one to two per cent in hypertension. No such studies were conducted in serum cholesterol levels among Ghanaians. Maybe it was not perceived to be a problem then. In those days the thinking was that hypertension was a disease of affluence and did not affect the poor. Increasing age may be a factor in the explanation of the increases in prevalence but the extent outstrips the age factor.
What were are eating patterns? Most Ghanaians then, ate local foods; fermented dough for the various types of kenkey, and banku with pepper sauce, okro stew or the various soups, ampesi or rice with palava sauce or gardeneggs stew or tomato sauces, waakye, fufu, tuo and konkonte (face the wall) and the variety of soups. The oils used for cooking were the tropical oils palm, coconut, palm kernel oils and shea butter, depending on one’s region of origin or habitation.
What changed?
We were told the tropical oils were not good as edible oils and were introduced to what was called essential oils which are the polyunsaturated vegetable oils. The food industry in the West had started producing vegetable oils to wean themselves from using tropical oils which had to be imported. After the 1966 coup d'état, we received donations of vegetable oils and that was the beginning of the love affair with what I now call the slow daily poison of the body.
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Nutritional science speaks to tropical oils being semi solid or viscous at room temperature and therefore capable of lining the vessels and causing occlusion. Nothing could be further from the truth. The plaques that block the vessels are low density lipoprotein which is from polyunsaturated fats and not the saturated fats. Medical Scientists, food scientists and biochemists in this country, including the author, have not conducted their own research to ascertain the facts but somehow some readily speak to the false information. The author however has followed the debate keenly and read the good works that have taken the food industry on. Saturated fats are nature's edible oils and preserve the intactness of the cell membranes. They protect the body from many ailments including the triple epidemics.
Lifestyle changes
The lifestyle of the Ghanaian has also changed considerably. There is increased use of fast and processed foods which are oil rich and contain more salt instead of the natural foods that were the main stay of Ghanaian eating. More significantly is the sedentary lifestyle where many people employed and unemployed do very little exercise. The days when the majority of us were either farmers or fishermen and walked for the better part of the day are long gone. Those who have cars drive everywhere and hardly walk. Those who use taxis and trotros do not walk half as much as they used to, once upon a time.
The use of alcohol contributes significantly to the calories on the income side. Alcohol provides calories but is of no nutritional value. Fruit juices are also a great source of calories and the rapidity with which we drink them has the potential of shocking cells and creating a cascade of adverse reactions. Whatever one eats and drinks constitutes the income side and the only thing on the expenditure side is exercise. The lack of it therefore, piles up the calories which get converted into the increased weight with all its repercussions, particularly on the heart.
We eat more salt than required, averagely 10 grams per day compared to the recommended six grams. Although smoking in Ghana has decreased considerably there continues to be pockets of smokers particularly among the poor. Nicotine affects the small blood vessels that serve every part of the body and increases the total resistance and therefore the pressure against which the heart has to pump to supply blood to all parts of body. This is what constitutes the increased blood pressure.
Pre-diabetics and diabetics
Many of our young people have developed a taste for the high-energy, high-impact drinks. They boost calories tremendously and constitute a problem, particularly in the group of pre-diabetics and diabetics. The pre-diabetics are a group with high and sustained blood sugar levels but not quite high enough for the diagnosis of diabetes. The numbers in this category are frighteningly high and that should worry all of us.
The problem with cholesterol is a huge one in our society. The body's mechanism under normal circumstances will always ensure that the serum cholesterol level is within the normal range. However cholesterol levels are high because the raw materials needed to repair the cell membranes which are provided by the natural saturated fat and/or fermented foods are usually not available or not in adequate quantities. The body can only use the polyunsaturated fat if it is in combination with cholesterol and so the body is programmed to produce high levels of cholesterol for this important function. The problem is greater with us the black population because we use a lot more oil in our cooking.
Whereas the standard Caucasian cooking is to use one tablespoon per serving, we pour the cooking oil. We therefore, on the average, have higher levels of cholesterol and it is not because we use tropical oils as we are made to believe; if that was the situation, our cholesterol levels will rather go down. Prior to 1966 when the oils used for cooking in Ghana were mainly the tropical oils, high levels of cholesterol was not an issue. Again, we do not eat more eggs than Caucasians who average 150 eggs per individual per year while we in Ghana only eat 12 eggs per year and therefore cannot attribute increased cholesterol to the eating of eggs.
Use of polyunsaturated fats and cooking oils
There is the need for us therefore, to take a bold decision on the use of polyunsaturated fat or oils for cooking. It is a travesty that even though palm oil and olive oils are both type II fats, we promote olive oil and deride the virtues of palm oil and yet the greatest concentration of octogenarians in Ghana are in areas where palmnut soup is the preferred soup and palm oil is liberally used. It is important also to appreciate that oil of whichever type, when subjected to excessive heat and or repeated heating, alters the chemistry and health impact.
It is however worse with the polyunsaturated fat or oils; the ability to withstand heat is poor and conversion to trans-fat is great. It is also worth noting that trans-fat is the most dangerous and causes the atheroma plaques that lead to the blockage of vessels, heart attacks and the various effects on all organs, feet and hands.
The ignorance and our unwillingness to learn and be proactive is worrying. We as a people tend to take the line of least resistance which is to accept what the food industry players and their cohort scientists say to us. We must be true to ourselves and argue out for Ghana in areas of comparative advantage. Our tropical oils are the best for cooking. Those are the oils nature produces in breast milk, meat and body fat. The body does not produce polyunsaturated fats anywhere and does not know how to deal with it. These fats serve as slow poisons and destroy the powerhouse of the body, the mitochondria, destroying slowly, the body's ability to convert blood sugar into the energy molecules ATP, leading to increased blood sugar levels.
Our practitioners should seek current and relevant information and proffer the best advice to their patients. Why should the patients continue the slow poison while taking antihypertensives, antidiabetic and anticholesterol treatment? Is that not the reason why we believe treatment must be for life? We enrich the pharmaceutical companies without questioning their modus operandi. Statins, anticholesterol drugs, are the best all-time performing drugs in the world because of the continued use of vegetable oils or polyunsaturated fats. Yet increased cholesterol is nothing that stoppage of the vegetable oils and a little exercise cannot cure rather than taking statins. Can we not conduct a double blind study comparing two groups, all on their current treatment, but one group will substitute the vegetable oils with our tropical oils for six months? The results will be very informative.
The author is a Pathologist and a campaigner on good nutrition.
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