In Mauritius, we have all the ingredients to be healthy even if not materially wealthy
It’s been a long time since I have been thinking about writing this article but as somebody with deep folk wisdom reminds me from time to time – and it’s about timing too! – ‘tout zaffaire arrivé quand so l’heure fine vini!’ That is, things happen only when their time has come. Sounds pretty obvious – except that it’s only in retrospect, when we have reached a degree of maturity that allows us to cast a look back at our life events in an overall context, that we are able to discern some patterns that make us gain at least some degree of understanding about how life in general unfolds. And then these little nuggets of wisdom we have heard and set aside have a way of surfacing back into our consciousness which we sometimes share.
What prompted me this time round are two articles about protein intake requirements in the American press. My general (during visits to the US) and medical experience has led me to become very skeptical about the periodic recommendations on what to eat or not to eat that come from that part of the world, where almost 100 million people are suffering from some form of diabetes, and nearly 50 million from obesity. Tackling these two scourges, and other modern ones, has become a global business, so that health care is now referred to as the health care industry!
Unfortunately, following this trend, for some protagonists and new players in the field medicine has become big business, a far cry from the Hippocratic Oath or its recast versions that should still be guiding the art of medicine. I do concede, however, that some sound, ethical business principles may be appropriately used to make health care delivery more efficient. But this is another debate.
A little knowledge is a dangerous…
I don’t know how it came to be that Mauritians became fixated on calcium, but the fact is that it is quite common for many a patient to pose me queries about calcium, given that I deal with bone conditions. Of course it is a good sign that they know that calcium is somehow associated with bones – but their knowledge stops there, and they are a perfect example of the adage that ‘a little knowledge is a dangerous thing’.
The questions that most frequently come up are variants of a few, such as, ‘ou pas croire a cause manque calcium sa docteur’ (don’t you think it’s because of a lack of calcium doctor?), ‘pas bizin prend un peu calcium?’(shouldn’t some calcium be taken?), ‘ou sur pas calcium sa docteur? (are you sure it’s not about calcium doctor?).
But there are also some confessions, ‘mo pe prend un peu calcium docteur’ (I am taking some calcium doctor), usually bought off the counter from a pharmacy; ‘mo fami la France/l’Angleterre ine envoye moi ene boite, dire moi prend, li bon pou lezo’(my relative in France/England has sent me a pack, told me to take, it’s good for bones). On a few occasions parents who have come with their kids suffering from some pain in the limb,even after injury, have asked whether it is because of a problem with calcium.
Without going into a surfeit of medical technicalities, let me point out that calcium deficiency is not frequent, and is usually caused by very specific diseases. Further, it has to be precisely established by thorough evaluation of the patient’s clinical status accompanied by precise measurements to establish the calcium balance profile of the patient. In the absence of a definitive diagnosis of calcium deficiency, merely taking calcium is simply useless, and also costly. On the other hand, any unnecessary intake of calcium supplements will result in them being evacuated in the stools – literally money going down the drain – precisely because the body maintains a very fine calcium balance. But also, an excess of calcium may lead to some other complications which I do not need to go into here.
A common condition which is associated with calcium concerns post-menopausal women, and is known as osteoporosis. It has got to do with hormonal changes that accompany the menopause, which result in a diminution of what is known as the bone mass, in which calcium is an important component. There are preventive measures that can be taken to lessen the impact of osteoporosis, and calcium supplementation is just one of the modalities of intervention that may be required. A blanket use of calcium is not warranted, and the best thing to do is to seek gynaecological advice, which may then include referral to a physician or orthopaedic surgeon as the case may be.
In general, except for the simplest of conditions such as a common cold or a mild pain self-medication for a long period of time must be avoided. All medicines are chemicals that are foreign to the body, and can potentially have side-effects, so it is better not to take any risk. In this respect the cooperation of pharmacists also is important, for them to abide by a code of ethical practice and not to pander to the whims or demands of patients who are not in the know about harmful effects of medication.
This reminds me of the case of a nurse when I was a junior doctor at the SSRN Hospital in the 1970s. He diagnosed himself as suffering from a heart condition, and took tablets of a drug called digoxin, which was usually prescribed for heart failure and that too under very strict specialist supervision. This guy ended up being admitted for a serious condition known as digoxin toxicity, which can be fatal. He was lucky that he got out of it. But there are equally potentially serious side-effects (allergy for example) that can happen with even the simplest medication, paracetamol for example, and so one must be really very careful and not indulge in unsafe practices of self-medication.
Americans discover vegetables
As regards the recommendations regarding protein intake, this follows the pattern of what comes from the US in matters of food: low this, low that at one time is the fashion, followed by high this high that after a while. Americans are now discovering vegetables as Columbus is supposed to have ‘discovered’ America – which had always been there with its indigenous populations. At one time it was low carbohydrate and high protein. Now the gears are being switched to high carb and low protein. How high, how low? Exact measurables are a tricky affair, and so too therefore the recommendations.
Fortunately there are some saner voices, although they are still paining to come into mainstream. One of them is Dr Dean Ormish, who relies more on natural than artificial foods and remedies. In his article ‘The myth of high-protein diets’, he writes: ‘My colleagues and I at the non-profit Preventive Medicine Research Institute and the University of California, San Francisco, have conducted clinical research proving the many benefits of a whole-foods, plant-based diet on reversing chronic diseases, not just on reducing risk factors such as cholesterol. Our interventions also included stress management techniques, moderate exercise like walking and social support. (italics added)
‘We showed in randomized, controlled trials that these diet and lifestyle changes can reverse the progression of even severe coronary heart disease. The more people adhered to these recommendations (including reducing the amount of fat and cholesterol they consumed), the more improvement we measured — at any age. But for reversing disease, a whole-foods, plant-based diet seems to be necessary.
‘In addition, what’s good for you is good for our planet. Livestock production causes more disruption of the climate than all forms of transportation combined. And because it takes as much as 10 times more grain to produce the same amount of calories through livestock as through direct grain consumption, eating a plant-based diet could free up resources for the hungry.
‘What you gain is so much more than what you give up.’
In Mauritius, we have more than enough vegetables of all varieties to meet our needs for most of the year, along with local fruits. If we really want, we can feed ourselves very adequately from a medical point of view, adding non-veg items according to our inclination and that too in moderate amounts. Along with exercise in fresh air available all round the island, and nurturing a pleasant social network, we have all the ingredients to be healthy even if not materially wealthy. But what does that matter: after all isn’t health our true wealth? Something to ponder seriously… especially as end of the year festivities approach à grands pas… (in rapid strides)