Cardiovascular diseases ....

The Sri Lanka Heart Association (SLHA) is advocating the need for easily available dedicated cardiac care countrywide to reduce the annual death toll of 25,000 due to heart attacks. To quote SLHA President Dr. Gotabhaya Ranasinghe, “We currently do have STEMI programmes but it is not a dedicate one. We need to have a programme where a patient from any part of the country can reach the nearest hospital in an ambulance that provides the necessary care till he has access to specialised treatment”.

At present, 24-hour STEMI care is available in government and private hospitals in Colombo, but in other regions the facility is only available for few hours each day (http://www.ft.lk/2014/07/12/heart-association-wants-dedicated-cardiac-care-countrywide-to-stem-25000-deaths-annually/). In addition to these untimely deaths, let us not forget, the stress suffered by the family members of these patients, the cost of medication and care, the adverse effects of the medicines all patients have to take and the reduction in productivity due to illness. The STEMI (ST Segment Elevation Myocardial Infarction, commonly known as a heart attack) programme is the cure or management of the condition that has been perfected that will either cost the patient or the Government Health Department a substantial amount of funds.

Is STEMI (“CURE”) the only solution for preventing cardiovascular diseases arising from Atherosclerosis?

Pic. 1 shows the neat “Tattoo” that cost the 44-year-old patient Rs. 4 ½ lakhs at a private hospital. With three arteries clogged, the by-pass surgery, the “CURE”, saved him from an untimely death from atherosclerosis. Are the majority of Sri Lankans able to afford expensive treatment such as this? Despite the “CURE” available to some, 25,000 patients apparently die annually from heart diseases.

How serious is the danger from Atherosclerosis in Sri Lanka (SL)? Is data pertaining to numbers of patients who die from this disease available? Atherosclerosis is known to be the number one killer in the USA. Due to this reason, the U.S. FDA announced in early November 2013, its preliminary determination that partially hydrogenated oil is no longer generally recognised as safe for use in food. The Department of Nutrition, Medical Research Institute, SL refers to “Trans fatty acid” as the killer (http://nutritionmri.blogspot.com/). Should Sri Lankans take these warnings seriously or ignore them?

What is therosclerosis?

It means the clogging of arteries. How?
 Fig. 1 explains it in greater detail. (1) A normal artery is like a new rubber band: flexible, strong, and elastic (2) The damage to the inner wall of the artery can be caused by high cholesterol levels among other reasons. (3) Over time, cholesterol, calcium and other substances accumulate in the wall of the artery and form fatty deposits called plaques. The narrower artery opening, limits blood flow. (4) These plaques can burst, causing a blood clot to form. The significant results and the after effects are;  

Result no. 1 - If Atherosclerosis narrows the arteries surrounding the heart, or if a clot forms and prevents blood from travelling to the heart muscle, it can cause chest pain (angina) or a heart attack. This is known as coronary artery disease. No. 2 - If Atherosclerosis narrows the arteries in the neck, or if a blood clot deprives the brain of blood and oxygen, a stroke or a transient ischemic attack  as a mini-stroke can occur. Both are accompanied by slurred speech, dizziness and a loss of control of facial muscles. No. 3 - When Atherosclerosis narrows arteries in your arms or legs, the circulation problems known as peripheral arterial disease may develop.

The usual suspects for these conditions are high cholesterol, a poor diet, obesity, smoking, too much alcohol and a sedentary lifestyle - (http://www.health.com/health/gallery/0,,20307285_2,00.html). Therefore the advice given is to avoid over indulging on foods that contain especially trans-fatty acids (TFA). TFA are artificial fats that are produced when oils are partially hydrogenated using hydrogen gas to solidify it for increasing the shelf life and taste.
When the danger from tobacco, alcohol and drugs are well-publicised for the benefit of the public in SL, why is the danger of the intake or over indulging on foods containing TFA not properly publicised? Why is the published and electronic media allowed to freely advertise the mouth-watering processed foods in their eye catching packaging and displayed on the shelves without details of the content of TFA in the product? The public, especially the children get mesmerised by the advertisements not knowing the hidden danger? The summary of a survey carried out by me of the ingredients printed on73 packets or wrappers of biscuits (29), chocolates (18), bread (8), easy to prepare foods (10) and cake (8) locally produced and displayed on the shelves of supermarkets are given below;

The major consumers of biscuits, pastries, cakes, chocolates  etc  are very likely to be the children and the younger generation while bread is consumed by most everybody as a food of convenience. Many of the older generation who are either diabetic or have high cholesterol levels will consume less of such foods. The danger of TFA will therefore be greater on the younger generation and children. What is the solution to prevent this danger of increased intake of TFA when the consumer is unaware of it? While the relevant authorities should take the necessary action to safeguard the consumer, the producer too has a responsibility to produce food products safe for consumption.

The use of partially hydrogenated vegetable oils (PHVO) in food products increase the % of TFA in the end product. If PHVO are not used in the manufacture of foods, the guarantee of zero TFA can be given to the consumer. Vegetable fats are also vegetable oils but, they are solid at ambient temperature. In order to make the oil a solid for the purpose of increased shelf life and better taste, it is partially hydrogenated to achieve these objectives. The fact that this process produces the TFA is now well known. Therefore, if a vegetable fat that need not be hydrogenated is used in the manufacturing process the products are likely to be free of TFA.

Why not try to prevent rather than wait to cure it?

Coconut and palm oil are vegetable oils best known in SL.  Globally, cocoa butter is the widely known and the most expensive vegetable fat.  Cocoa butter substitutes such as, shea, illipe, kokum, mango seed kernel and sal are the commodities known as “exotic” fats. None of these vegetable fats need undergo partial hydrogenation but, their use in SL is not possible due to their high cost. Pentadesma fat is a vegetable fat that is neither widely known nor commercially produced but, is a substitute for cocoa butter as well as a confectionery fat that need not undergo hydrogenation.

To quote Prof. Dr. Vijay Shukla, Chief of IFSC (www.ifsc.dk), “Producing Pentadesma fat will be the right solution to provide the consumer an ingredient that is free of TFA and also provides nutritional properties of long chain fatty acids as of cocoa butter. This innovative investment in the alternative crop will enrich Sri Lanka with a product which could be exported extensively to the wider world”.

What is Pentadesma fat?

Pentadesma fat is extracted from the seeds of the species,Pentadesmabutyracea. The natural stands of the species are confined to the forests in many countries in the tropical West African Region. It is a perennial tree crop that will be productive for well over a century, producing a fruit and seeds once or more each year depending on the distribution of the annual rainfall. Hardly any interest is shown on this species in other countries. Several Lipid Scientists have carried out extensive research on the fat extracted from the seeds and despite their findings, the species has not been established on a commercial scale in any country.  Introduced to Sri Lanka in 1897, the 117-year-old tree in the National Botanical Garden, Peradeniya  still continues to produce a crop of fruit and seeds annually. With seeds obtained from this tree, a small plantation was established in November 2009 in the low country wet zone. It has so far not reached maturity but, successful growth is obvious. See pictures, 2.3 and 4.

Pentadesma can be established as a mono-crop on a plantation scale and inter-cropped with other perennial crops that tolerate shade. It can also be established at a low density in established plantations and small holdings. While the fat extracted from the seed is a trans-fat free commodity, the perennial tree crop will be beneficial to the environment, give the prospective grower an annual income and ultimately yield a fortune in good quality timber to a future generation.                 

Isn’t the production of a TFA free confectionery fat an ideal objective for the corporates to show their social responsibility?
The writer is attached to International Food Science Centre. A/S, Denmark
 He can be contacted on hsdes59@yahoo.com