‘How to address rising cases of heart attack, cancer, diabetes in Nigeria’

Dr. Kingsley Chiedu Amibor is a Public Health Expert, Clinical Pharmacist and Deputy Director Pharmaceutical Services Federal Medical Centre, Asaba. Amibor in this interview with The Guardian made recommendations on how to address rising cases, morbidity and mortality due to heart failure, cancer and diabetes in Nigeria. The hospital pharmacist also established the association between regular consumption of energy drinks with heart attack and artificial sweetener as ‘possibly’ carcinogenic agent. CHUKWUMA MUANYA writes. 

•Explains why energy drinks cause heart attack, artificial sweetener as ‘possible’ cancer-causing agent

The World Health Organisation (WHO) recently confirmed that the artificial sweetener, aspartame, found in Diet Coke, Diet Pepsi and other food products as ‘possibly’ carcinogenic. What is the true picture? Are there alternatives?
Aspartame is an artificial (chemical) sweetener widely used in various food and beverage products, including diet drinks, chewing gum, gelatin, ice cream, dairy products such as yogurt, breakfast cereal, toothpaste and medications such as cough drops and chewable vitamins.

Aspartame is used as an ingredient in beverages (such as diet sodas, light or low-sugar juices and flavored waters), dairy products (such as light yogurt and low-fat flavored milk), nutrition bars, desserts (such as sugar-free puddings and gelatins, light ice cream and popsicles), chewing gum, sauces, syrups and so on.

Aspartame is found in more than 5,000 foods and drinks, and is far sweeter than sugar. It is approved as a tabletop sweetener and ingredient in gum, cereals, instant coffee, dairy products and other items. Common foods and drinks with aspartame include: tabletop sweeteners, including NutraSweet, Equal and Sugar Twin; beverages and drink mixes, such as Diet Coke, Coke Zero, Diet Snapple, Fanta Zero, Sprite Zero, Crystal Light and Wyler’s Light; sugar-free gum, including Trident, Extra, Wrigley’s and Mentos gum; gelatin-based products, including sugar-free Jell-O and Royal Gelatin; syrups, including Mrs. Butterworth’s Sugar Free Syrup and Log Cabin Sugar Free Syrup and so on.

As more people globally shy away from sugar, artificial sweeteners like aspartame have stepped in to fill the gap in people’s favorite recipes, with more than 5,000 products manufactured with aspartame.

The WHO cancer research arm released a report recently, categorizing the artificial sweetener as “possibly carcinogenic to humans.”

Is aspartame safe at any level?
The generally acceptable daily intake of aspartame is 40 milligrammes per kilogramme of body weight.  Though Aspartame has been approved by the U.S. Food and Drug Administration for use in food products, with the agency concluding the additive is “safe for the general population.” But questions have lingered about its safety. A recent research paper noted that “the results of its long-term use remain difficult to predict.”

Aspartame does not impact blood sugar or insulin levels, thus making it a popular sugar substitute in foods for diabetics. However, while numerous studies have determined aspartame to be safe in moderation, some research linked aspartame consumption to cancer. One observational study of more than 100,000 adults in France concluded that individuals who consumed larger amounts of artificial sweeteners, especially aspartame, had a slightly elevated risk of cancer.

Are there other negative effects of aspartame?
Aspartame may also cause headaches, seizures and depression. Nevertheless, some international agencies like the Food and Drug Administration (FDA) and American Cancer Society, however, both still deem aspartame safe for human consumption. I for one will suggest use of moderate amounts of aspartame for now. I personally do not support an outright ban for now. Rather, further long-term research has become inevitable to ascertain the true safety value of aspartame. Some manufacturers are contemplating use of natural sweeteners as a substitute to Aspartame. These include honey, coconut sugar, agave nectar and so on.

Recent studies have linked energy drinks with heart attack?
An energy drink is a beverage that typically contains large amounts of caffeine, added sugars, other additives, and legal stimulants such as guarana, taurine, and L-carnitine. These legal stimulants can increase alertness, attention, energy, as well as increase blood pressure, heart rate, and breathing.

These drinks provide an extra boost in energy. However, the stimulants contained in them can have a harmful effect on the nervous system. Some of the unwanted effects of energy drinks are dehydration, heart complications (such as irregular heartbeat and heart failure) anxiety (feeling nervous and jittery) and insomnia. Faster heart rates leading to arrhythmias and hypertension are the most common outcomes of high-caffeine consumption. Others are irritability, insomnia, tremors, seizures and hazardous cardiovascular events.

Energy drinks can cause harm to the heart due to the amount of added sugars and calories they contain.

Energy drinks, like many other sweetened foods, can damage the heart and blood vessels over time. It is unlikely that a single energy drink would suddenly trigger a heart attack. However, they can exacerbate other heart disease risk factors, especially heart arrhythmias.

There is an alarming rise in diabetes worldwide. What is the true picture?
Diabetes is a chronic condition that results from insufficient insulin production by the pancreas or inefficient insulin utilisation by the body.

There are currently about 537 million people in the world with diabetes, with about 24 million in Africa. The number of people with diabetes rose from 108 million in 1980 to 422 million in 2014, to its current figure of about 537 million.  It is projected that this will more than double to around 1.3 billion people by 2050. It is also estimated that the figure for Africa could rise to around 55 million by 2045.

The prevalence of diabetes is increasing worldwide, especially the risk of type 2 diabetes among the population. Prevalence has been rising more rapidly in low and middle-income countries than in high-income countries.

The increase in prevalence globally is not uniform: some countries and regions are particularly badly affected. For example, prevalence rates are expected to reach 16.8 per cent in North Africa and the Middle East and 11.3 per cent in Latin America and the Caribbean by 2050, compared to an estimated 9.8 per cent globally. Currently, the prevalence is 6.1 per cent.

Diabetes is increasing at an alarming rate in the United States (U.S.). As at 2022, cases of diabetes have risen to an estimated 37.3 million. In 2019, 283,000 children and adolescents less than 20 years in age, had diagnosed diabetes. This included 244,000 with type 1 diabetes. Also, 1.6 million adults aged 20 years or older, or 5.7 per cent of all US adults with diagnosed diabetes, reported both having type 1 diabetes and using insulin. Between 2014 and 2015, the estimated annual number of newly diagnosed cases of type 1 diabetes in the U.S. included 18,291 children and adolescents less than 20 years old.

Compared to adults aged 18 to 44 years, incidence rates of diagnosed diabetes were higher among adults aged 45 to 64 years and those aged 65 years and older.

In Nigeria, approximately 5.8 per cent (about six million) of adult Nigerians are living with diabetes. This indicates that one in 17 adults is living with the disease. However, this prevalence might be higher as many cases of diabetes in the country are not reported due to inadequate access to healthcare. More than half of those with the disease are unaware of their condition.

The Nigerian prevalence rate has been predicted to double by 2040.  Prevalence rate of diabetes is highest in the South-South region of Nigeria and lowest in the North West.

What are the causes?
Growing rates of obesity, poor diets, and lack of physical activity, among other factors, have contributed to a more than three-fold increase in the number of adults living with diabetes in the Americas in the past 30 years.

In part by demographic shifts. The majority of the cases are type 2 diabetes, that is linked to obesity and largely preventable. Sedentary lifestyle of the populace is one of the factors responsible for increasing levels of Diabetes. People in rural areas walk and carry out physical activities and the like which burn off their extra sugar intake. But the sedentary lifestyles of those in urban areas with little or no physical exercise increases the risk of type 2 diabetes.

In Nigeria, prevalence is largely attributed to the lifestyle changes  caused  by urbanization and its results, industries producing unhealthy diets including sugar-sweetened drinks, lack of exercise, tobacco use and harmful use of alcohol.

A large majority of people living with the disease in Nigeria have little or no knowledge of diabetes and its complications, and this has been increasing the risk of developing the disease. This low knowledge of diabetes – prevention, testing and treatment, has been contributing to the increasing prevalence of cases and mortality from the disease in Nigeria.

Furthermore, the lack of access to proper education for the prevention of Type 2 diabetes, lack of education for those living with all types of diabetes, and access to affordable treatment, including insulin, are factors aiding rising cases of the disease.

A recent survey revealed that the increasing consumption of sugar-sweetened beverages exposes Nigerians to a higher chance of coming down with diabetes. It showed further that Nigerians are exposed to a 26 per cent risk of type two diabetes by the regular consumption of one to two cans a day of sugar-sweetened beverages.  A continuous increase in the volume of carbonated drinks (sugar-sweetened beverages) consumed in Nigeria has been reported and this is expected to increase in the coming years. As at the end of 2022, it was reported that on the average, each Nigerian took at least 26.2 litres of carbonated drinks.

What are the implications?
The rapid rate at which diabetes is growing is not only alarming but also challenging for every health system in Nigeria and elsewhere in the world, because of complications associated with the condition if not properly managed. Prevalence appears to be higher among older adults.

The growing number of people with diabetes is in part driven by rising obesity.

What are your recommendations on how to reverse the trend?
Diabetes remains a major public health problem, and can be effectively prevented or managed through public health awareness creation on healthy lifestyle choices, capacity building of the health workers and improving the capacity level of the care for diagnosis, treatment and support.

There is a need for more effective mitigation strategies. Increased access to diabetes education among the populace is critical to the prevention and management of the disease.

Also, access to diagnostic tools is crucial to aid diagnosis of diabetes. There should be ready access to affordable, safe and effective anti-diabetic medications to treat diagnosed patients.

There is a need for training and retraining of health care workers in the prevention and management of diabetes at community levels, especially on self care efforts, lifestyle medications and so on.

Modifying our lifestyle and a healthy and nutritious diet is the key to preventing the disease. If left unchecked, and without management and lifestyle changes, diabetes can lead to several debilitating complications.

The setting aside of a day known as World Diabetes Day by WHO on November 14th every year, is a step in the right direction as it aims at creating awareness of the growing burden of the disease, and strategies to prevent and manage the threat.

Nations across the world including Nigeria, are encouraged to observe the yearly World Diabetes Day in their various countries including this year, 2023. The Day highlights the importance of diabetes prevention and response efforts in line with the goal of the WHO to change the health system toward ‘prevention care and not sick care’.

One strategy to achieve this in Nigeria, will be through seminars, road shows, radio and television talk shows, inter school competition and quiz on Diabetes with prizes, and so on.

There is a need for religious and community leaders, stakeholders and the media to intensify awareness creation about diabetes to improve the prevention of the disease and the health-seeking behaviour of people with the disease.