For a long time, Mr Apokwo, a native of Ezeagu community in Enugu, a state in the South-Eastern part of Nigeria, thought that his frequent urination was because he took Agbo – the traditional herbal mixture or concoction believed to contain potent herbs that are capable of treating different ailments.
Like the average Nigerian and their preference for staple food, he continued to indulge in starchy foods.
A few weeks before this revelation to Guardian Life, the attendant at the chemist shop had told him that his bouts of fatigue, weight loss and constant urination were nothing but signs of the twin devils of “typhoid and malaria”, and gave him medications for them. The sharp pain and sudden swelling he had in his flank, leading down into his groin, prompted his wife to take him to the hospital, where he was diagnosed with chronic kidney failure – one of the complications of poorly managed diabetes.
“Not only is diabetes an ailment with a lot of long-term complications, but it can also actually kill in the short-term if not properly managed,” an endocrinologist in a Nigerian teaching hospital who preferred to be unnamed told Guardian Life. While it is well known that rapid increases in blood sugar over a short time can lead to immediate death, long-term uncontrolled blood sugar levels can lead to blindness, heart and kidney disease as well as diabetic foot disease.
Globally, diabetes is one of the 10 leading causes of death. According to the International Diabetic Federation (IDF), Nigeria has the highest occurrence of diabetes sufferers and people with impaired fasting glucose in Africa. In 2020, a meta-analysis reported that approximately 5.8% (about 6 million) of adult Nigerians are suffering from diabetes. Like other middle and low-income countries, two-thirds of those with diabetes are undiagnosed.
Diabetes is a lifelong disease in which the body cannot produce enough insulin. In some other cases, it cannot use the insulin it produces. In both instances, this leaves the affected person with an excess amount of sugar or glucose in the body, which is then ferried around in the blood, capable of causing damage to all the tissues and organs of the body. Insulin is the key hormone involved in the storage and controlled release of glucose in the blood. Sugar is transported into the muscles and fat cells with the help of insulin for use as energy. Without insulin, glucose remains in the blood, which over time can cause serious health problems such as heart disease, vision loss and kidney disease.
Symptoms of diabetes include:
- increased thirst and urination
- increased hunger
- blurred vision
- numbness or tingling in the feet or hands
- sores that do not heal
- unexplained weight loss
There isn’t a cure for diabetes yet, although there are promising discoveries, none of these have been shown to be of practical use at the moment. What this means is that diabetes is required to be closely controlled and managed. There are medications to help maintain the blood sugar at an appropriate level and there are other options for maintaining a decent blood sugar level, including healthy lifestyle habits like proper dietary intake and exercise.
Diabetes is of two main types, aptly called type 1 and type 2. In addition, diabetes may develop in pregnant women and that is known as gestational diabetes. In type 1 diabetes, what occurs is, the body’s immune cells attack the organ that produces insulin. The reason for this is unknown. This inability to produce enough insulin for its usage leads to high sugar levels in the blood, called diabetes.
“Due to attacks on the organ responsible for producing insulin, called the pancreas, by soldiers in the body that normally fights infections, called immune cells, not enough insulin is produced for the body’s use”. This means that people with type 1 diabetes often find out very early in life. In contrast, type 2 diabetes tends to develop much later in life and is thought to develop from the body’s resistance to the action of insulin. Simply put, there is enough insulin, but its effectiveness wanes as time progresses, leading to excess sugar, which can be harmful to the body. While type 1 diabetes is typically due to some problems with the internal workings of the body, type 2 diabetes is usually because of lifestyle habits and some risk factors, like obesity, being black or having other illnesses like poorly controlled blood pressure or cholesterol levels.
A common topic of discourse is the role of carbonated drinks and sugar in the development of diabetes. Large-scale research shows that regular consumption of sugary drinks, including cola, lemonade and energy drinks, raises the risks of obesity, heart disease and type 2 diabetes. For people with an existing risk, it appears the increased intake of sugars increases their risk of developing diabetes. As such, it is recommended that not over 10% of energy each day comes from sugars. This equates to 70g or less of sugar for men and 50g or less for women.
Nigerians are no strangers to herbal medicine. In a country where the rural population was put at 48.04% in 2020, the resort to herbal medicine is largely relied upon. More so, while access to standard healthcare has been a plaguing problem across the country, Nigerians are finding alternatives to it.
Despite the calls to ban the selling of Agbo from the roadside hawkers by the Herbs Sellers Association of Nigeria, Agbo continues to be very popular. A few concerns are surrounding this recommendation. In recent times, there have been rising allegations that medications such as paracetamol have been used to adulterate the mixture to varying extents, for a myriad of reasons. Highlighting the dangers of using this concoction, medical experts expressed that its long-term use can lead to kidney and liver damage because of the toxic levels of medications and the herbal components of the concoctions.
Regarding diabetes treatment, Agbo is not the only source that Nigerians have opted for. Mrs Shola, a retired nurse, is convinced that bitter leaf is a potent resource in managing blood sugar. Her husband, a diabetic patient, has been managed using bitter leaf for years with great results. What she has done is to add bitter leaf water to his daily routine, requiring him to consume it at specific periods and with few side effects. According to her, bitter leaf is not only effective in the present time but had been used in previous generations across the world to aid in the alleviation of diabetes. To buttress this, a paper in the Medical Journal of Islamic World Academy of Sciences surmises that bitter leaf has properties that not only reduce sugar levels but heal the pancreas.
The medical consultant who spoke to Guardian Life opines that while it is true that it has some beneficial effects in managing diabetes, the belief that it can solely treat diabetes should be neglected. “We may be right about the use of herbal concoctions, but until universal medical practice conducts some research and says that its use is consistent with the regulation of blood sugar, it should not be recognised as the sole treatment for diabetes,” she says.
Dr Ruth Uzo, a certified nephrology nurse and a deputy director at the Enugu State Teaching Hospital, says that bitter leaf is a brilliant source. “If they drink it in the morning, it prevents it from getting worse. Bitter leaf and Agbo cannot do everything, however. They need to see an endocrine specialist in the hospital. What we are running from is complications of diabetes because it affects the nerves, the organs and every part of the body. I will also advise such people to use Moringa.”
For people living with diabetes, one of the symptoms is fatigue, a direct/ironic contrast to exercise. Dr Uzo notes it is a necessity. “They can take a walk, perform indoor exercises; lie on the bed, straighten their legs, do pace exercise or brisk walking, just to ensure some form of activity for around 30 minutes per day or 180 minutes over the course of a week. The idea is for them to be fit and retrain their bodies to use sugar effectively.”
Although this may seem tasking, it has been shown to be very helpful in helping curb outrageous increases in blood sugar over time.
One of the horrors of living with diabetes is the eventual cause of premature death if caution is thrown to the wind, a fear that caused Mr and Mrs Augusta to change their diet. As a rule, people diagnosed with diabetes should have a higher concentration of protein, vitamins, vegetables and fibre-rich foods compared to starchy foods or carbohydrates, as there is little to no insulin to break it down. It is, however, important to note that avoiding carbohydrates in its entirety or filling up on other food classes may be detrimental. The primary goal with dieting in diabetes is with portion control, which enables one to “use” up the resources available from food before the next meal, to prevent excesses. Exercise is also one of the healthy lifestyles that a diabetic will have to adopt.
“Do you know that most of these starchy foods like garri is not too good for a prediabetic or someone that has already been diagnosed?” she chips in.
In collaboration with a dietician, Guardian Life wrote about foods that diabetics can eat.
Here’s a list of healthy local foods which can be enjoyed on a diabetic menu:
- Nigerian soups: Vegetable soup, Okra soup, Edikan Ikong, Waterleaf soup, Ogbono soup, Egusi soup, Afang soup
- Staple foods (swallow): Wheatmeal fufu, Guinea corn fufu, Unripe plantain fufu
- Stews and sauces: Tomato stew, Garden egg stew, Shredded chicken sauce, Shrimp sauce, Fresh Fish sauce or stew, Smoked fish sauce
- Low-carb meals: Brown basmati rice and stew, Unripe plantain porridge, Moi Moi, Boiled plantain with stew, Roasted plantain with fish sauce, Plantain with beans porridge, Beans and whole wheat bread
- Healthy snacks: Garden eggs with peanut butter, Coconuts, Boiled groundnuts, Akara balls, Tiger nuts, Nigerian pear
- Comfort foods: Isi ewu, Nkwobi, Cow leg, Cow tongue, Fish pepper soup, Chicken pepper soup, Snail pepper soup, Peppered snail, Liver sauce, Gizzard pepper soup
- Healthy drinks: Zobo without sweeteners, Guinea corn (Dawa) kunu, Millet (joro) kunu, Unsweetened yoghurt