By DARE AKOGUN
Trans fats according to medical practitioners have no known health benefits and are a major contributor to cardiovascular diseases and stroke worldwide. In Nigeria substantial progress has been made in the last ten years, however, the delay to gazette the laws to regulate the trans fat content in food has become worrisome,
“Had it been I knew how awful it is to have a stroke, I would have been more cautious and protective of my health and most especially what I eat. I have lost my job and have not been able to secure another one all because I don’t walk and look like I used to. I also get rejected everywhere I show up for an interview. My life has not been the same,” says Ms Kemi Shuaib, a 37-year-old mother of two from Niger State who has been battling stroke for seven years now.
“It all started in 2015, when I woke up to ease myself around 3: 00am and I just couldn’t move. I tried all possible ways but it seemed impossible, the best I could do was to make a phone call to neighbors. I was rushed to the hospital and after eight hours of running tests, the doctors confirmed I had a stroke due to high blood pressure, which I never knew I had,” she explained.
Just like Shuaib’s case who was battling with stroke, partly due to many years of eating junk food, because of the nature of her work and ignorance about trans fat, Non-Communicable Diseases, mainly cardiovascular diseases, cancers, and diabetes are the world’s biggest killers and have now been termed “a silent epidemic”, by medical experts.
The economic burden of Non-Communicable Diseases on families and Nigeria in general is significant because the cost of treatment is high, is usually paid out of pocket and death is mostly premature, cutting victims at their prime of productivity.
According to a report published in February 2021 in the European Journal of Preventive Cardiology, a journal of the European Society of Cardiology, the number of patients with heart failure worldwide nearly doubled from 33.5 million in 1990 to 64.3 million in 2017.
The authors said the rising rate of heart failure in the low, low middle-, and middle-income countries such as Nigeria “is driven by risk factors such as hypertension, diabetes mellitus, obesity, smoking, and other unhealthy lifestyles.”
In 2018, as part of efforts to reduce the health crisis arising from the consumption of hydrogenated meals, the World Health Organization (WHO) called for a global elimination of industrially produced trans fatty acids by 2023 through an initiative called the REPLACE Action Framework which serves as a guide to all countries for a policy or regulatory enactment.
REPLACE stands for Review dietary sources of industrially-produced trans-fat and the landscape for required policy change; Promote the replacement of industrially-produced trans-fat with healthy fats and oils; Legislate or enact regulatory actions to eliminate industrially-produced trans-fat; Assess and monitor trans-fat content in the food supply and changes in trans-fat consumption in the population; Create awareness of the negative health impact of trans-fat among policy-makers, producers, suppliers, and the public, and Enforce compliance with policies and regulations.
The WHO in a report in 2021 pointed out that cardiovascular diseases (CVDs) are the leading cause of death globally.
The report stated that an estimated 17.9 million people died from CVDs in 2019, representing 32% of all global deaths. Of these deaths, 85% were due to heart attack and stroke.
It added that cancer, cardiovascular diseases and diabetes were responsible for 38 percent of fatalities in 2019, increasing from 24 per cent in 2000 largely due to weaknesses in the implementation of critical control measures, including prevention, diagnosis and care.
Out of the 17 million premature deaths (under the age of 70) due to noncommunicable diseases in 2019, 38% were caused by CVDs.
Most cardiovascular diseases can be prevented by addressing behavioural risk factors such as tobacco use, unhealthy diet and obesity, physical inactivity and harmful use of alcohol.
The World Health Organisation’s Regional Director for Africa, Dr. Matshidiso Moeti, while speaking in April this year said the mounting burden of Non-Communicable Diseases poses a grave threat to the health and lives of millions of people in the second largest continent in the world.
According to her, the growing burden of Non-Communicable Diseases exerts pressure on treatment and care services. In the African region, the number of people living with diabetes, for example, is to hit 47 million by 2045, up from 19 million in 2019.
She says that findings from the 2022 WHO Non-communicable Disease Progress Monitor showed that between 50 and 88 percent of deaths in seven countries in Africa, mostly small island nations, are traceable to these ailments.
The report also discovered that in seven other countries, the majority of them Africa’s most populous entities, the diseases claimed between 100,000 and 450,000 lives yearly.
Also, the rising cases of heart attacks leading to stroke like that of Kemi Shuaib, and sudden deaths in Nigeria and indeed the world have been associated with an increase in intake of industrially produced Trans Fatty Acids, which are replete in vegetable oils, like fried and baked foods, popcorn, chin-chin, bean cake, noodles, plantain chips among others.
The World Health Organization described Industrial trans-fat as unhealthy fats that are produced when vegetable oils are heated or when they are “hydrogenated”.
It went further to describe hydrogenation as the process of bubbling hydrogen gas through the oil to make the oil solid. Stopping the hydrogenation part of the way through the process results in partially hydrogenated oil, a product with a butter-like consistency but much cheaper to produce than butter.
The organization said that food manufacturers have used partially hydrogenated oils to improve food texture, food flavour stability, and keep some foods fresh for a long time. It is sold as ‘margarine’, partially hydrogenated oil is the main source of industrial trans-fat.
Experts have however indicated that avoiding trans fats in food could prevent nearly 100 million premature deaths globally.
A consultant cardiologist at the University of Ilorin Teaching Hospital Dr Ayo Ogunmodede, said foods rich in Trans Fat raise Low-Density Lipo-protein or ‘bad cholesterol. He said for decades, evidence has been mounting that even a small amount of trans fat increases bad cholesterol in the blood and decreases the amount of good cholesterol raising the risk of coronary heart disease and heart attacks.
He said globally, high risks of heart disease are associated with industrially produced Trans Fatty Acids consumption.
He stated that partially hydrogenated oils were first introduced in the 20th century as a replacement for butter and became more popular in 1950s through 1970s with the discovery of the negative health effects of saturated fatty acids.
According to him, the reasons for the popularity of the oil are simple: “The oils were relatively inexpensive to produce when compared to solid animal fat, which he also said increases the shelf life of food, tasted good, and at a time when saturated fats in butter were vilified, they were billed as a healthy alternative.
He said local foods with high industrially produced Trans Fatty Acids and unhealthy fat content include biscuits, fried foods (like French fries, pizza, puff puff), deep-fried fast food (like akara, fried chicken), plantain chips, sauces and seasonings, ice cream, doughnuts, pastries, cakes, chin-chin, and pre-packaged snacks, microwave popcorn, margarine, and other confectionery.
He said diets high in trans-fat increase cardiovascular disease risk by 21 percent and deaths by 28 percent.
WHO recommends that trans-fat should be limited to less than one percent of total energy intake (2.2g/d) with a 2000- calorie diet,” he said.
Talking about the relationship between trans-fat and heart attack, he said that Trans- fat increases levels of LDL- cholesterol, which is an established biomarker for cardiovascular disease risk, as well as decreasing the level of HDL- cholesterol, which transport cholesterol from arteries to the liver for excretion through bile.
“Replacing trans-fats with unsaturated fatty acids reduces the risk of heart disease, partly by ameliorating the negative impact of trans-fats in blood lipids. Additionally, evidence suggests that trans- fat may increase inflammation and endothelial dysfunction and also increase tendency for platelet aggregations”.
The Director-General, National Agency for Food and Drug Administration and Control (NAFDAC), Prof. Mojisola Adeyeye, in an interview said that industrially produced Trans Fatty Acids are now known for increasing risks of health problems such as coronary heart disease, cancer, diabetes, obesity, liver dysfunction, and infertility.
Adeyeye said WHO estimates that diets high in trans-fat increase the risk of heart disease by 21 percent and deaths by 28 percent.
The NAFDAC DG said that the agency is optimistic that deaths as a result of cardiovascular diseases, which are part of the estimated 110,000 Nigerians and 500,000 people who die every year globally due to heart failure and 64.3 million patients with the condition worldwide, will be prevented and averted with proper regulation and legislation against industrially produced Trans Fatty Acids.
There is a seemingly increase in the sudden deaths of young people as she emphasized poor health systems as part of the health challenges.
To ensure Nigeria joins the rest of the world in limiting trans fatty acids in its food chain, Professor Adeyeye said the National Agency for Food and Drugs Administration and Control (NAFDAC), in collaboration with the Federal Ministry of Health has updated two existing regulations, namely, the Fats and Oil Regulations 2019’ and the ‘Pre-Packaged Food, Water and Ice (Labelling) Regulations 2019.
While progress has been made in putting together the regulations and getting the NAFDAC Council to approve it, she acknowledged the bureaucratic delays in getting the regulations gazetted and assured Nigerians that the ministry in conjunction with the National Agency for Food and Drugs, Administration and Control (NAFDAC) is working as fast as possible with all the necessary departments to pass the bill.
She said the delay has become costly as it allows manufacturers of foods high in trans-fats, interested only in profits, to continue the business of marketing lethal foods.
The NAFDAC DG however expressed optimism that the regulations are with the ministry and would soon be gazetted.
When passed into law, the first regulation will limit trans-fat to 2g per 100g of total fat in all Fats, Oils, and Foods while the latter will ensure proper labelling of food products in Nigeria in the context of industrially produced TransFats.
Speaking at a training for journalists from the South-Eastern region in Enugu, capital of Enugu State between 6 -7 May 2022 on Trans-Fat Regulation as a Public Health Emergency: Beyond the Rhetoric, In-Country Coordinator, Global Health Advocacy Incubation (GHAI) Joy Amafah, emphasized on why the fats and oils regulation must be gazetted.
She cited this as the permanent solution for relevant government agencies to be able to monitor and have control over the oils produced for the populace to consume.
Consumers are at the receiving end as they consume oils that lead to their ill health and death in some cases. Prolonged intake of such foods is also linked to increased risk of Alzheimer disease and certain cancers that overtime, affect insulin sensitivity and the risk of type 2 diabetes, especially in individuals with diabetes in their genetic make-
Kazeem Olaniyi, is the CEO of MK Small Chops and Grills, based in Ilorin with more than seven years in the business, said he had heard about trans-fat, but does not really understand what it means.
The National Agency for Food and Drug Administration Control Act, is the enabling law for the regulation of the manufacture and sales of food and drugs in the country, however this act does regulate the amount of trans fat in foods produced in the country.
Food, Drugs and Drinks are essential requirements of human existence and the volume of business involved in the supply of these necessities is very high and profitable, which If left unregulated, manufacturers and suppliers of these products may engage in underhand business strategies in order to maximize their profits whilst endangering the life of the consumers, many citizens like Ms Shuaib are victims.
He revealed that the major ingredient used in preparing his small chops are vegetables like carrots, cabbage, and meat with little frying.
Olaniyi revealed that there are no associations or groups for caterers in Ilorin and as such no one is really regulating the activities of the thousands of caterers operating in Ilorin. He, however, revealed that the company is registered with the Corporate Affairs Commission.
Talking about making use of hydrogenated oils or reused oils to prepare food, he said he is aware that the majority of caterers make use of it to prevent wastage and their lack of knowledge about the health hazard it can cause for their clients and families.
“Many people use the oil they used in frying to cook soup or make jollof rice and other edibles,” he said.
Olaniyi, revealed that the only time he had an encounter with NAFDAC was in Lagos where the officials came and requested to supervise the process, he underwent to prepare his small chops and other edibles in the event.
Tayo Alayande, a Kwara based civil servant, said he has never heard about the word or even fatty acids, however he said he has heard of so many reports of people dying of heart attack in recent times and one of the causes according to health practitioners is too much intake of oil.
However, he called on the ministry of health to create more awareness of the causes of sudden death in the society due to bad eating habits among others.
How do trans fats affect our health?
Unlike other dietary fats, trans fats raise the “bad” cholesterol in humans, causing it to build up in the arteries, and also lowers the body’s “good” cholesterol, which helps remove excess cholesterol from the body.
Some Nigerians like Mrs Shuaib with a high level of ignorance on trans fat and its association with heart failure and other chronic diseases are at the mercy of one ailment or the other who they will be battling with at the end of their life and only hope to live long enough on medications.
Trans fats in our food and how to avoid them
Although there is no safe level of trans fat consumption, the World Health Organization recommends that total trans fats intake does not exceed one percent of total energy intake, which translates to less than 2.2g per day for a 2,000-calorie diet.
It is advisable when choosing fats and oils for domestic or commercial cooking, it is advisable to choose healthier options like olive, soybean or canola oil.
One major challenge however to the elimination of trans fat in foods in Nigeria that is not clearly addressed in the proposed Regulation is the sale of unbranded cooking oils.
Emphasis is focused more on packaged products or food containing fat and oils by the proposed law, but it does not specifically address unbranded-cooking oils, which are sold in the open market and easily accessible to so many Nigerians.
This Investigative Report was supported by Corporate Accountability and Public Participation Africa (CAPPA) and partner, Global Health Advocacy Incubator (GHAI) under her #TransfatFreeNigeria Project.