Understanding and Tackling Poverty-Inflicted Diseases

by Adepoju Paul Olusegun

As a struggling teenager, Eve blackcurrant flavoured drink was my affordable substitute for Coke®. The 5g net weighing sachet that cost five Naira (now twenty Naira) yields more than six bottles of bottled drink when dissolved in water. It even tastes better and becomes more refreshing when served chilled. But when my financial status improved, I forsook Eve.

Few days ago however, our paths met again at a local supermarket, where it stood on a shelf in its glorious unmistakeable famous wrapper. I couldn’t resist the urge to buy one. With my medical science knowledge, I thoroughly analysed the sweet content of the powder that once placed me on the same pedestal with the nouveau riches — the only social class that could afford energy drinks (better known as soft drinks) without thinking thrice. Three contents caught my attention: citric acid, aspartame and sodium cyclamate.

On its own, citric acid is harmless, but it becomes harmful when abused, misused or overused by its users. Citric acid is naturally found in a variety of fruits and vegetables. High concentrations of it are found in lemons and limes. It is often used as a natural preservative to add sour taste to foods and soft drinks. However, taking too much citric acid can create a variety of problems.

The most common symptoms of citric acid overdose include stomach cramps or pain, diarrhoea, nausea or vomiting, loss of appetite, increased sweating and swelling, and pain in the abdominal or stomach area. In rare cases, yellow colouration of the eyes or skin may occur. Less common symptoms of too much citric acid are more serious.

Symptoms include bloody or black, tarry stool, or bloody or cloudy urine. There may be a frequent urge to urinate or a decrease in the amount of urine. Other symptoms may include fever, headache and an increase in blood pressure. Individuals may also experience back, side or muscle pain. Other symptoms include nervousness or restlessness. Skin rashes, hives or itching may also occur. Sores, ulcers or other blemishes may appear on the lips or in the mouth. There may also be sore throat; swelling of the face, fingers, ankles, feet or lower legs are other potential side effects. Unusual bleeding or bruising, tiredness or weakness and weight gain, could indicate citric acid overdose.

More serious episodes from side effects may include severe stomach pain, on-going diarrhoea or vomiting. Other severe side effects include coughing up of blood, slow breathing and an uneven heart rate that may be too fast or too slow. In some cases, there may be confusion, anxiety, weakness, irritability and mood changes. Seizures and convulsions are also possible. These are too much hamper to purchase with just five Naira.

The next content – aspartame, otherwise known as NutraSweet, consists of two amino acids, aspartic acid and phenylalanine. The phenylalanine content is of concern to individuals with inherited recessively transmitted genetic disorder known as phenylketonuria (PKU). Approximately one out of every fifty people in the United States carries a single defective PKU gene; the prevalence is higher in Nigeria. It can cause mental retardation and other serious neurological problems that could impair brain functions. Currently, there is no cure; the only available management option is a strict diet that limits phenylalanine. My favourite Eve is surely not one of such.

The third component is sodium cyclamate which is a salt (an ester) of cyclamic acid that is used as a sweetener. It is artificially synthesised. The cyclamates were first used in the United States in the early 1950s, but were banned in 1969 after a study of them in rats implicated them as possible carcinogens.

Eve is just one out of the several hundreds of manufactured products, and thousands of ways that the lower class is struggling to compete with the upper class in the society with associated fatal health hazards when precautionary measures are not taken. Meat pies represent another similar category of such products.

Most restaurants and fast food joints in Nigeria sell meat pies at an average price of hundred and fifty Naira per pie which is almost the daily income of Nigerians occupying the lowest class. In desperation to make them compete with the upper class, they also eat meat pies, though with a whole lot of difference, and at a cheaper cost.

Instead of having chopped meat as filling, the poor man’s “meat pie” often contains potato which is quite nourishing if consumed on the day of preparation. But medical problems arise when the pie stays for more than twenty four hours under improper preservation conditions. At this stage, putrefaction (decomposition) sets in as a result of bacterial activities. Although the exterior part of the pie might look clean, sumptuous, even palatable, the inner core of the pie could be rotten. This is largely due to the poor preservation method used by the local bakers.

Big eateries have microwave ovens and other heating machines that could generate enough heat that would kill any bacteria – foreign pathogen or harmless normal flora – that might be lodged anywhere in the pie. These preservation devices are quite expensive and beyond the reach of the baker who bakes pies that would go for fifty-Naira-a-piece.

The poor preparation and preservation methods could create great public health problems such as diarrhoea, dysentery, typhoid, food poisoning and several other food borne diseases. Hence when the poor taunts the rich with arteriosclerosis, obesity and diabetes, it’s worthy to make them realize their own health troubles.

Starchy staple foods constitute another category of worry for the health of “struggling” Nigerians. Foods like akpu, eba, amala, tuwo, and the rest are the delight of the Nigerian lower class, members of which eat these treats on a daily basis.

In the morning, most Nigerian families would choose tuwo, egbo, noodles, bread, rice or yam, all of which are polysaccharide carbohydrates. In the afternoon, solid foods like akpu, amala, garri, eba or Semovita – all of which are carbohydrates – are nationally ingested; while at night, akamu/ogi/pap, yam, bread, potato, kunu and the rest are the food of choice, all of which are also starchy carbohydrates. While members of the lower social class might derive satisfaction in filling and feeling the stomach, the cumulative risk to health cannot be overemphasized.

What many Nigerians don’t know is that digestion doesn’t end by storage in the stomach; it entails a series of specific enzyme/hormone activities. Since we keep bombarding the body with carbohydrates, the pancreas – the organ that secretes insulin is the worst hit since it keeps firing and producing insulin for the metabolism (handling) of ingested foods. As age sets in, the insulin-secreting activity of the organ decreases and the body’s ability to handle sugar (carbohydrate) reduces considerably. This is what happens in type II diabetes.

While much emphasis, attention and public funds are committed to issues like HIV/AIDS, cancer, malaria, tuberculosis, cardiovascular disorders, diabetes and other popular health conditions, the success of such efforts had not commensurate with the massive investment in the various projects majorly because they are often treated out-of-context.

Nigeria is in dire need of better public health policies that address the peculiar health challenges of Nigeria and Nigerians. Despite the pitiable standard of living of the average Nigerian, a lot could still be achieved with the available resources at the disposal of every Nigerian, if only they know what to do, and how? There is a lot of work to do concerning the nutritional status of Nigerians and more attention should be given t

o healthy food combinations that are safe – both in the short and long terms.

Unlike the current nutritional advices that are focused on ensuring that individuals eat “balanced” diets that contain all the food classes, the twenty first century Nigerian nutritional challenge should be focused on recommended dietary allowances (RDA) that would decrease the risk of chronic diseases for most individuals in the population considering the fact that not every Nigerian knows or can afford to consult nutritionists.

We should also consider individuals with nutrition-sensitive health conditions that are not even aware of their health status in the first place, talk less of keeping away from products containing substances that their health conditions forbid.

It’s unfortunate that although the various governments’ efforts at ensuring that every Nigerian, no matter the social status eats well, are difficult to come bye, the recommended dietary allowances (RDA) at the hospitals are similar to what we’ve been using for several decades. Our RDAs should be updated to reflect new knowledge of nutritional needs. Our current out-dated RDA shows that our nutritionists are either not researching, or the government is not following their research works.

We also need to raise the consciousness of Nigerians to the importance of eating healthy foods by making nutritional facts available to them. If the federal government of Nigeria can afford to spend billions of Naira to celebrate the nation’s fiftieth independence anniversary, we shouldn’t become prudent when it comes to promoting health and nutrition awareness for every Nigerian. This becomes important when we consider the fact that a lot of diseases could be prevented when people eat right.

Studies of populations that eat many fruits and vegetables reveal a decreased incidence of diet-related cancers, and laboratory studies have shown that many fruits and vegetables contain phytochemicals, substances that appear to limit the growth of cancer cells.

We can only imagine the number of Nigerians that would be spared the agony of living with preventable cancer if only they are aware of the right fruit to choose, and the herbs to chew. NAFDAC should also be more alert to its saddled duty of protecting Nigerians.

Like I was ten years ago, not every Nigerian, regardless of social class, knows what citric acid, phenylalanine, sodium cyclamate, aspartame mean; that’s why we have the various regulatory agencies. They should ensure that whatever the label reads, every food substance on the shelf is safe.

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