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‘Poor attitude to health and lack of infrastructure responsible for high incidence of diabetes’

By Kehinde Olatunji
18 November 2021   |   2:44 am
Dr. Samuel Oghene Etatuvie is a community pharmacist and Director General, Nigeria Natural Medicine Development Agency (NNMDA) Kofo Abayomi, Victoria, Lagos.


NNMDA has developed scent leaf-based tea for management of diabetes

Dr. Samuel Oghene Etatuvie is a community pharmacist and Director General, Nigeria Natural Medicine Development Agency (NNMDA) Kofo Abayomi, Victoria, Lagos. Etatuvie in this interview with The Guardian ahead of World Diabetes Day (WDD) 2021 and after NNMDA’s one-day interactive session with the media to sensitise the public on “Rational Use of Natural Medicine for the Management and Prevention of Diabetes” said the agency has made giant strides in the development of herbal remedies for diabetes. He spoke to KEHINDE OLATUNJI.

What informed this renewed interest in tackling diabetes?
THE increase in the prevalence of diabetes mellitus worldwide has become a major global and societal burden to both developed and developing countries.

Diabetes is a complex and multifactorial disease and one of the top 10 leading causes of death globally. Sub-Saharan Africa and indeed Nigeria have the highest incidence of both diagnosed and undiagnosed diabetes.

The increase in the incidence of diabetes both globally and nationally has become worrisome, especially in Nigeria, owing to the peculiarity of her peoples’ poor attitude to health, poor health infrastructure, poverty level and demographic crises in the face of a rapidly rising population. The implication of this is that Nigerians must, as soon as possible, look deeper into nature to seek solutions to this public health menace.

What are the complications?
The long-term damaging effect of diabetes mellitus includes dysfunction and failure of various organs, especially the eyes, kidneys, nerves, heart and blood vessels.

Can it be managed?
Diabetes is one very key disease that is affecting millions of people across the world. In Nigeria, our people also face its tremendous challenges. We want to use this opportunity to contribute to the creation of awareness for diabetics. Though it has the potential to cause death for our people but it is not a death sentence. It’s something that can be managed using both the orthodox method, which all of us are aware of. But most interestingly is the potential of using our natural medicine health systems. And apart from the drugs you take, there are other natural medicine methods that can be used to maintain and take care of diabetics. Even mere walking for four or five kilometers or 30 minutes walk on a daily basis is one of the natural ways of maintaining or managing diabetes.

We have a lot of vegetables in this part of the world; they are everywhere and very good. Vegetables increase your fibre intake; they reduce the availability of sugar in the body. Also, eating well can take care of diabetics.

Avoiding things that can shoot up your sugar level is also very important. But it is also very critical to know your status. There are some basic symptoms that would indicate that there is a likelihood of somebody having diabetes, like frequent urination, being very thirsty, and sometimes very hungry, above your normal range. These are the critical signs that when you have, you should go to the hospital for checkup.
Considering the high cost of conventional drugs, attendant side effects and complications, are there natural cures?

In response to damaging adverse effects of oral hypoglycemic agents and their consequences to health, the World Health Organisation (WHO) expert committee on diabetes had listed, as one of its recommendations, that traditional methods of treatment for diabetes should be further investigated. In Nigeria, the use of herbal medicine alone or in combination with orthodox drugs is quite common. In a study in Lagos, 305 (67.3 per cent) reported herbal medicine use, among whom 108 (35.4 per cent) used herbal and conventional medicines concurrently; 206 (67.5 per cent) did not disclose use to their physician. Other studies showed that consuming fruits and vegetables could reduce markers of oxidative stress and inflammation in patients with type-2 diabetes. There are reports that natural compounds across Nigerian medicinal plants are used in the treatment of diabetes in the country. The usefulness of medicinal plants in the treatment and management of T2D and its complications, as well as male infertility, has been attributed to their phytochemical and nutritional constituents. These plant constituents provide anti-diabetic activities through various mechanisms. Studies show that Rauvolfia vomitoria leaf extract releases its anti-diabetic action by enhancing the regeneration of the pancreatic islets, thereby increasing insulin secretion and plasma insulin level. This invariably results in a corresponding decrease in blood glucose. The therapeutic effect of Cola nitida infusion against diabetic cardiomyopathy is through the reversal of biomarkers’ activities and levels for Type 2 diabetes while maintaining an intact morphology.

Other plants with antioxidant and anti-diabetic potentials are bitter leaf, Aloe vera, ginger, scent leaf, okra, utazi, iru/dawa dawa, cinnamon, bitter melon, milk thistle, fenugreek, guava, insulin plant, African baobab, Alligator pepper, Goat weed, onions, Devil tree, cashew, pine apple, sour sop, cabbage tree, breadfruit tree, resurrection plant, Bird eye pepper, paw paw, African star apple, lime, kolanut, among others.

What effort is the traditional medicine system making to manage the disease?
In the traditional medicine system, we have done a lot of documentation on medicinal plants across the country. With such efforts, we have been able to identify some specific medicinal plants that are common to us and have been proven scientifically that they have the capacity to reduce blood sugar. Such herbal products have a lot of antioxidants that reduce stress. They help to also control the level of sugar in the body. Some of them are very common such as bitter leaf, uziza, ‘Hospital too far’, among others. A lot of research has been done, confirming that they are very good. They have been proven to have the capacity to reduce blood sugars.

Has NNMDA been able to turn these researches into acceptable products?
The NNMDA, in pursuance of parts of its research mandate, has developed a herbal remedy from our indigenous medicinal plants that possess blood sugar lowering properties, that can be useful in the management of diabetes. The NNMDA’s Ocimum Herbal Tea (NAFDAC Reg. No.: A7-4105L) has been evaluated for safety; efficacy and blood sugar lowering effect, using streptozotocin-induced diabetic rats.

NNMDA’s Ocimun Herbal Tea is developed by the agency for the management of diabetes mellitus. It is a combination of indigenous medicinal plants that have exhibited hypoglycemic and antioxidant properties from preliminary investigations. It can be used as a baseline for self-regulation of diabetes. From the basic research work and safety analysis conducted on the product, it possesses some phytochemicals that are effective in reducing blood sugar level and is also safe for consumption.

Diabetics are used to orthodox medicine. Are you saying there are better alternatives?
Many of the sufferers are used to pharmaceutical products. Our belief is that these pharmaceutical products are very expensive and the side effects are usually very high. From research, it has been proven that a family spends between N15, 000-N20, 000 to purchase these drugs, maybe on a daily or weekly basis. With the level of poverty that we have in this country, how is it sustainable? We have a natural method of taking care of these things with minimum side effects.

We have a product, it’s in tea form, purely developed from the traditional medical knowledge from the researches. The researches have been carried out throughout the globe. From that, we have been able to develop our herbal tea that is used to manage diabetes type 2. NAFDAC has given us approval; it is safe and good for human consumption. Instead of spending maybe N20, 000, you have activities that do not cost you money, like walking and taking tea. It gives you the same end result as the pharmaceutical products you are using and it has the potential to be safer.

We are talking to people who can partner and do the commercialisation of the tea product. We want it to be as cheap and readily available as possible. If we, as a research institute, continue to produce at this level, it might cause maybe N3,000 to N5,000 but that is not our focus. Our focus is to make it readily available at an affordable amount. So, we are talking to industrialists and individuals that can push it into the market for people to use.

It is easier to scientifically put them together. All of us take tea; we have different types of tea in stores and everywhere. If we form the habit of using natural products, it’s cheaper, simpler, effective and safe. You have an advantage in using natural medicine over our known pharmaceutical products. Some of the natural products help to build up the different organs. They induce immunity, which is needed to take care of other diseases in the system. Those are the solutions we provided. There’s no chemical in it. It’s a combination of leaves and proper drying. After that, we run it through all quality control methods. We didn’t do it like other non-research institutes or individuals. We want our people to know that there are alternatives to using pharmaceutical products. Our major focus as an agency is that this product should be used rationally. It has been proven that if you use any drug for a long time, there may be side effects. The challenge for the management of diabetes is that it’s not something that you will cure completely, but if you manage it well, you will live to full old age. My father was discovered to be diabetic when I was still in the College of Pharmacy, University of Benin. He lived up to 95 years before he died. He lived more than 40 years after he knew about it.

What role do you think the government can play on this?
We are a government institute and they have been funding us to the level they think they can afford because there is demand for funds from the government. We will continue to appeal to the government to fund research and development, especially the ones that relate to traditional medicine knowledge. We have a lot of what we call huge diversity in bioresources in the country that can be exploited. With the experience of COVID-19, the government should give more funding to research institutes. We have brilliant research officers, not only here, but also in other research institutes, even the universities. And we also have a challenge. The government has established TETFUND, and this is directed to the universities only. Research is not carried out in universities alone. Research institutes themselves need special funding. Also, individuals should come out and pick up this entire research outcome, to commercialise them because if you don’t, it will continue to remain at the level of pilot production.

What is your advice to the nation about herbal medicine on diabetes?
I want to urge all our people to take their health seriously whether it is diabetes, cancer or hypertension, once you notice a change, it is better to start seeking help to determine your status than leaving it to aggravate and it becomes more difficult to manage.

I want to also encourage everybody to do the activities that can help him or she prevent or reduce to the barest the negative impact of diabetes on longevity. You should do a lot of sports and activities that would help to reduce the quantity of sugar in your bloodstream. Although sugar is a source of energy, there is a need to also burn some of that excess sugar. There is a minimum the body can carry at a particular time.

What is the position of food or dieting in the management of diabetes?
Control the food you take. The kind of food you take in the management of diabetes is very important. We encourage people to take a lot of vegetables and reduce carbs. We are not saying you shouldn’t take carbohydrates because you need the energy to move around and think, but you should reduce the quantity of carbohydrates you are taking. Also, be very conscious. Some fruits, like bananas, pineapple, and apples are very good but sometimes they can also increase your sugar level. It varies from individual to individual. Know the type of food you take and as you are taking it, be sensitive. Yam has a very high glycemic index; if you take it in large quantities, you will definitely increase your sugar level. Our message today is that people who have proven to be diabetic should have confidence that it’s not a death sentence; it can be managed successfully, using both preventive methods and good food is from sources that do not need chemicals. The quality of your products is determined by the quality of the raw materials. When we got the raw materials we passed them through safety analysis.

You are a pharmacist. When you look at orthodox medicines for diabetics, what are the likely aftereffects, compared to herbal medicines?
Most of the drugs you’ve seen produced from herbs are from what you use on daily basis. They are foods; they already have the capacity that aligns with your body system. The possibility of having very severe side effects are very minimal and they also have a way to build up and strengthen the body organs that eliminate the outcome of metabolism of the drug in your system. The challenge of orthodox medicine is that some of them actually affect your organs, especially the kidney. If it impacts negatively on the body organs, it becomes a challenge for you. So, these are the side effects that make our herbal medicines have an advantage over other drugs.

There are some African countries where insulin is given free. There are many other things poorer countries in Africa do to assist diabetics. But in Nigeria, everyone is left to fend for him or herself. What is your take on this?
True, everybody is on his/her own and that is what we are used to. If your access to primary health care is not guaranteed, then your access to secondary or tertiary institutions cannot be guaranteed. The COVID-19 pandemic has also exposed the level of infrastructure we have in the country, but I think the government is making efforts and we will encourage the government to continue to focus on ensuring that our citizens have better access to things that will help manage diabetic patients. The theme for this year also talked about access. If one cannot get access to the formal health systems, there are other opportunities that you can make use of and that opportunity depends on your attitude. For instance, if I realise that I am diabetic, from the information that regular exercise, eat well, taking a lot of vegetables and you minimise things that can aggravate your condition if that is the only information that you got and you abide by it, you don’t even need to go to the regular health care centres to take care of your diabetes. Why don’t you look inward and take charge of your own health through these alternatives. You need to be properly guided by professionals, ask questions. Look at brands that are made in Nigeria, that you can trace and hold the people accountable.

What is diabetes?
Diabetes is a metabolic disease that presents as high blood sugar. The hormone, insulin, moves sugar from the blood to be stored or used for energy. With diabetes, the body either does not make enough insulin or cannot effectively use the insulin it makes. In Type 1 Diabetes, the immune system attacks and destroys cells in the pancreas, which are responsible for insulin production. While in Type 2 Diabetes (T2D) the body becomes resistant to insulin and sugar builds up in the blood.

What are the major causes and signs of this disease?
Let us establish the fact that diabetes can be hereditary and one can also pick it up as they grow. So, what is the first thing, to prevent it, you have to be conscious of your health status. Sometimes, you have excessive sweating and especially at night, you go for urination often. First of all, these are things that should make you ask yourself questions, ‘this was not the way my body system was working.’ The first step is to go and do a check-up. Then, we should also be very conscious of the fact that one of nature’s ways of keeping ourselves healthy is by doing exercise. Simple walking should be made a constant feature in your activities. Even if it is a 30 minutes walk on a daily basis, it will help you to reduce and control the sugar in your bloodstream. So, those are the clear methods of prevention. We talked about poor health. It is very obvious that many of us do not take our health seriously.

Sometimes, from all cases we have seen, when people have these symptoms, they do not take them seriously, they wait until they have aggravated before going to the health centres. If you notice these changes in your body, and you take the right steps, I’m sure you will be able to manage it. It will not be aggravated. So, what are we doing as agencies? One of the things we needed to do is to sensitize the public, and for this particular project, we have used social media massively, we have sent out bulk SMS, and we have also done radio jingles.

For the next three weeks, this information on how you can prevent diabetes will be on air. So, we should be able to reach as many as 20 million people out of the over 200 million people that are in this country. So, anybody that listens and takes special notice should be guarded on the steps to take if he notices that there is a change. And do not forget, diabetes is an underlying illness that also aggravates anybody affected by COVID-19. So, if you are able to manage your diabetes and sugar level status very well, it means that you are at least ahead of others affected by COVID-19. If you listen to those who have underlying challenges like diabetes, hypertension and all that, they are actually more at risk than those who do not have it.