•Professor of Ophthalmology explains how consumption of bread, cake, soft drinks, fruit juice, others may lead to death, blindness
From Aloysius Attah, Onitsha
“Man shall not live by bread alone, but by every word that proceeds out of the mouth of God.”
That popular Biblical verse, in Matthew 4:4, was the epic response given by Jesus Christ to Satan while the latter tempted the Lord in the wilderness.
But a Professor of Ophthalmology at the Nnamdi Azikiwe University, Awka, Anambra State, has taken the statement to another level. The don insisted that it was even better that man does not live by bread at all.
Professor Sebastian Nwosu, President, Ophthalmologist Society of Nigeria, noted recently while delivering the 18th Faculty Lecture of the National Post Graduate College of Nigeria that it was better to totally avoid bread, as its disadvantages far outweigh the gains. The lecture by Prof Nwosu, also a Distinguished Fellow of the Faculty of Ophthalmology at the National Post Graduate College of Nigeria, was held at Dolly Hills Hotel, Onitsha.
The lecture, ‘Man shall not live by bread at all’ examined the dangers associated with bread consumption, especially as it affects diabetic patients with sight challenges.
Talking on the preventive approach to diabetic eye disease, Prof Nwosu noted that bread and other forms of junk food never constituted part of the Nigerian dietary staple in the past. He regretted that recently, as part of the culture of conspicuous consumption and the indiscriminate imitation of industrialised societies, many Nigerians are now hooked to bread and other forms of junk foods.
He said the adverse effects on the people’s health were now showing, with increasing incidence of diabetes mellitus, hypertension and cardiovascular diseases with their deadly complications.
He said the term bread was used in his lecture to include all simple, refined or processed carbohydrates, including flour products, such as bread, doughnuts, cakes and others.
He also mentioned table sugar, soft drinks, fruit juice, energy drinks, ice cream and similar beverages. He noted that the production and marketing of the various forms of junk foods, including sugary beverages, had become big business accruing huge profit in the country.
Nwosu said nutritionists advocated the eating of brown bread in preference to the white bread, hence the cliché: “The whiter your bread, the nearer your grave.”
Talking about the role of bread (refined carbohydrates) in diabetes mellitus, Prof. Nwosu stated that all carbohydrates taken as food would ultimately be broken down to glucose, but he explained that the process was slower with complex carbohydrates in which not more than 20% ingested is absorbed, leading to high serum level of glucose.
He added that persistent intake of refined carbohydrates would chronically expose the body to high blood sugar levels while high concentration of sugar in blood would make enormous demand on the pancreas, leading to increased insulin production. Insulin, he said, in turn pumped excess sugar into the cells where they are utilised or stored.
Nwosu explained that persistent high blood glucose level with time overwhelms the insulin pump mechanism, leading to inefficient clearance of glucose from the blood stream with a resultant effect being a situation of insulin resistance whereby clinical diabetes mellitus ensues.
The Professor of Ophthalmology explained that diabetes mellitus was a metabolic disorder in which there is a high concentration of sugar in the blood due to absolute or relative insulin lack.
He gave the hope that there were evidences to show that good glycaemic control through dietary care and regular exercise could reverse diabetes mellitus for up to 10 years but also disclosed that late complications of diabetes mellitus leading to blindness and visual impairment were due to chronic exposure of the cells to high glucose levels.
While talking about the epidemic of diabetes mellitus in Nigeria, he said several studies had shown that the incidence and severity of diabetes mellitus and its complications were related to caloric intake and quality of carbohydrates, such as the amount of sugar consumed per day.
“In one of the earliest studies on diabetes mellitus and its complications in Nigeria, Osuntokun documented that patients who consumed a lot of sugar were at the greatest risk. Recently, a Swedish study reported that persons who ingested 400ml or more of soft drinks per day were 2.4 times more likely to develop Type 2 diabetes and those who consume up to 1000mls per day have greater than 10 times the chance of coming down with the disease.
“Obesity is a known risk factor for Type 2 diabetes mellitus thus, a lifestyle characterised by conspicuous consumption especially of refined carbohydrates and sedentary habituation will invariably lead to overweight, obesity and Type 2 diabetes mellitus.”
Talking about the Ocular complications of diabetes mellitus, Prof Nwosu said the disease adversely affected every part of the eye, leading to diabetic eye disease. He listed complications in this regard to include chronic eyelid infection and inflammation, acute orbital infection, ocular surface disease, sudden transient changes in refraction, cataract, neovascular glaucoma, diabetic retinopathy, macula edema, asteroid hyalosis and neuro-opthalmic disorders.
He said these complications were the reasons for visual impairment and blindness in diabetes mellitus, noting that cataract and retinopathy are the two commonest blinding complications.
The lecturer disclosed that Laser intravitreal pharmacotherapy and vitrectomy were the standard treatment modalities for diabetic retinopathy but sounded a caveat that the treatment approaches are not magic bullets.
Nwosu further said that Laser photocoagulation aimed at sealing leaking capillaries and microaneurysms in order to preserve vision, adding that in this process, parts of the peripheral retina are deliberately destroyed in order to preserve central vision.
Following laser therapy, he said visual field defects might develop and be severe enough to limit automobile driving. He said intravitreal pharmacotherapy involved the intra ocular injection of inhibitors of vascular endothelial growth factors (VEGF. He listed various commonly used VEGFs and noted that through their anti-angiogenic activities, the drugs block VEGF expression, reduce intraocular ischemia and preserve vision and in some cases, visual loss is reversed with the patient gaining three lines of visual acuity.
Prof Nwosu also disclosed that this type of treatment required several monthly injections, in some cases up to 13 times to stem the tide of visual deterioration.
He listed the challenges of treating diabetic eye disease to include patient’s late presentation of case to the doctor, poor follow up, expensive treatment, lack of facilities and few or absent trained manpower.
In summing up, the lecturer said he had tried to show evidence that the incidence and prevalence of diabetes mellitus and diabetic eye disease in Nigeria had steadily increased over the past 50 years. He recommended that the key to the prevention of diabetic eye disease and its visual consequences were in the prevention of diabetes itself.
“A team work approach is required in order to deliver optimal care to persons living with diabetes mellitus. The public should be repeatedly made to be aware of the role of refined carbohydrates in the development and worsening of diabetes and its complications. The need to minimize the intake of refined and processed carbohydrates, including bread, is urgent in order to curb the menace of diabetes mellitus and its ocular complications. Modern information and communication technology, including the social media should be employed in disseminating health education,” he said.
Prof Nwosu also paid tributes to distinguished colleagues in the faculty, including Drs. O.O Ogundipe, BGK Ajayi, AA Onakoya, R.E Umeh, VA Pam, H.A Ajibode, C. O Bekibele, A Adeoye, A. Fashina and D.S Ademola-Popoola.
He also felicitated with the chairman of the event, Emeritus Professor O.O Mbonu, noting noted that as the Chief Medical Director, Mbonu supported the establishment of Diabetic Eye Clinic at Nnamdi Azikiwe University Teaching Hospital, Nnewi. He also lauded his colleagues at Guinness Eye Centre, Onitsha, especially the Head of the Centre, Dr. A.I Apakama and the Chairman of the Local Organising Committee, Dr. N. E Okpala.
The faculty lecture also featured presentation of awards and recognitions to some individuals and corporate organisations that had supported the Guinness Eye Centre, Onitsha, in providing eye care services and training activities.
Some of the awardees included Guinness PLC, Pfizer PLC, Patrick Uche Apakama, a Pharmacist, Chief Livinus Ukpaka, Rotary Club of Onitsha, and Chief Dan Chukwudolue of Dozzy Group, among others.