The Medical iconoclastic series: Misapplication of special diets in Nigeria

In Nigeria,  a typical pointer to a diabetic patient residing in a particular abode is when you see cut unripe plantains drying out in the sun around the neighborhood,  often in unsavoury and unhygienic conditions, just because these people have been taught that it is plantains that they should eat and in various formulations in order to ensure lowered blood sugar. This is so divorced from the truth that it is stiffling. When you tell say a 55-year old man who has marinated in ‘eba and egusi’ or ‘rice and stew’ all his life that he cannot indulge in these ever just because he is a diabetic,  life itself invariably stops for this person. He goes to  ‘Nkwobi joints’ and watch his contemporaries chase down these delicacies with a glass of chilled beer and just sit through this Pavlov’s experiment with an excruciating sense of nostalgia and i ask how have you improved this person’s quality of life as the nutritionist that advised him so. I do not want to go through the various scenarios but suffice it to say that if i accidentally take food belonging to a diabetic person here in a hospital in the USA, I will gobble it so ravenously without any inkling that it is a diabetic diet unless someone told me so at the end of my meal, and that includes  the tea that follows it which with such tasty sugar substitutes like ‘equal’ etc, makes a nonsense of the tasteless beverage a typical diabetic in Nigeria is subjected to.  Bottomline, in the USA, emphasis is on reducing calories without tampering with taste thereby ensuring the quality of life is maintained whilst in Nigeria emphasis is mostly on taste alteration to a state of abject hopelessness without a concomitant consideration of calories. Breaking news people,  there is really no diabetic diet in the sense that we have it in Nigeria!  You are allowed to live your life and not be sentenced to  ‘death’ at the age of say 55years just because you were diagnosed with diabetes. Your diabetic diet is one which is balanced with carbohydrates,  proteins, fats, minerals and trace elements all in moderation with the only taboo being simple sugars like bottled soft drinks( called minerals in Nigeria) and malt drinks, but even taking a swig of these maybe once in 2weeks is not going to be exponentially deleterious. The other thing i would advise us to avoid is cigarettes but this is a redundant point because compared to other climes, Nigerians do not smoke cigarettes and this abstention has been one of the drivers of upward tick in life expectancy despite the other crushing indices that either stagnate or depress our life expectancy in Nigeria! So, as a diabetic, you are allowed to eat almost everything you were eating before but in moderation, except to a large extent mineral soft drinks and malt drinks and these you will need if your sugar suddenly bottoms out anyway. So, if you used to eat ‘eba and soup daily, or ‘Nkwobi with beer’ every 3days, or drink tea with sugar every morning or rice and stew every 3days, try having these like once a week or thereabout but never just cut them out. Go out on Sunday evenings with your friends and damage that plate of Nkwobi to extinction and chase it down with your choice of liquid but not minerals or malt. Eat you eggs, etc to moderation. The mantra is how many times was i doing this before, then reduce to say about 30% as before. The only thing i advise you 100% cessation is cigarettes!!! No food is out of bounds totally but spaced out, balanced and in moderation. You are allowed to eat a finger of banana once a week if you were eating it daily before.  Put your plantains into the roladex like other foods and do not ascribe any primacy or even supremacy to it. Plantains are also broken down to sugars finally in the body, even if to a lesser extent. And whilst there, enough with this unhygenic drying of unripe plantains in the sun with flies perching on it and people jumping over them whilst parambulating. The diseases emanating from this sloven practice will kill you even before the diabetes itself does so. You cannot stop living life itself just because you are a diabetic.  That itself will kill you a thousand times before your actual death. In all, do not forget your exercises and strict adherence to your medications.

For hypertension,  emphasis is on decreasing salt intake to the barest minimum,  especially uncooked salt. Of course your exercises and avoiding cigarettes are not far behind. Whilst this issue is about diets, I  want to let you know that religiously taking your medications is also is a duty not an option, but i will discuss medications another day. Those telling you not to eat red meat, eggs, etc, should try the man next door.  In as much as i will advise moderation in everything,  total cessation is uncalled for and even counterproductive.

I shall take cardiac and cholesterol diets together because high cholesterol invariably predisposes one to cardiovascular diseases.  Recently,  i found out that a 65-year-old woman that i know her family well has not been eating eggs, red meat, palm oil and other condiments for years on the advice of her medical provider just because she committed the ‘heinous’ crime of having high cholesterol. That was the first time i ran berserk and actually pushed back my intended topic for this week just to address this issue in case there are others out there still serving their time in this diet ‘jail’. Needless to say that this woman has been liberated from her own ‘jail’ already and is enjoying her regular diets, in moderation.  What got me miffed was when she was told her leg swellings were from her high cholesterol.  Are you ‘fricking ‘ kidding me??!! High cholesterol in itself is totally asymptomatic!!! It is inadvertently found out during lab tests and can only clog up your arteries to narrow blood supply to your vital organs and can lead to sequelae of the decreased perfusion like heart attacks, strokes, kidney  damage and limb perfusion deformities,  over a long time. Leg swelling could be due to venous insufficiency,  congestive heart failure,  kidney failure,  liver disease and local factors like arthritis, all of which high cholesterol has no or at most marginal roles in engendering, and even then cannot be said to be a sign of high cholesterol.  Take for instance eggs, one of the best foods given to man hy God: a typical Nigerian does not even eat enough eggs all his life. It is usually a delicacy reserved for long trips like buying it in Onitsha head bridge or Umunede en route to Lagos from Aba, eaten at times unhygenically. Even in elitist homes in Nigeria, it is not eaten like here in the USA where an average person eats like 5 eggs a day from childhood except in situations of deliberate restraint. Fast forward to when the person is diagnosed as having high cholesterol due to a multiplicity of factors, then the person is barred from eating eggs? Eggs have minuscule amount of cholesterol with both beneficial and harmful cholesterol in about the same amount. Research has shown that the needle is not moved an inch if a high cholesterol patient takes one egg daily especially boiled eggs. Even healthy average Nigerians do not take this much ordinarily, so what is all the hullabaloo about eggs? Please eat your normal diet in moderation and do not starve yourself to death.  Foods high in saturated fats like hard margarine,  butter, meat with a lot of fats, cheese, coconut oil, palm oil  and vegetable oils with high cholesterol content should not be totally avoided but taken in moderation too. Please live your life,  exercise and take your medications accordingly, you have high cholesterol, you did not commit sacrilege!

Eight years ago one of my close friends was diagnosed with hepatitis. Do not even get me started on how this was diagnosed, a topic for another day since I was told sometime by a patient that she had no blood test but a urine test showing proteins and wasctold she has hepatitis,  but suffice it to say that this person was stopped from eating meats, fats and fried foods, beers, eggs and just a whole gamut of life-sustaining foods for the preceding 6 months before I went to Nigeria that December and saw my friend practically evaporating.  His main grouse specifically was not being able to eat ‘Nkwobi and Isi ewu’ and I promptly restored him back to full unrestricted diet and he has been robust since then. There is nothing to avoid here except cigarettes and habitual alcoholism as different from recreational alcohol intake except in the acute phase of a real hepatitis case where you need to avoid the usual suspects above together with fatty foods in order not to stress the liver, but after this phase, all bets are off.

New topic next week and weekly. Rejoinders are welcome