The average lunch plate of most Lankans contains 70% carbs and salt dense foods and only 30% vegetables and proteins
The theme for this year’s Nutrition Month, ‘Taste Without sugar’ takes on a new level when it involves elders. Many people who have developed unhealthy food habits and lifestyles over a long period, continue to do so as they advance in years, despite repeated awareness-raising programs cautioning them to change their eating habits and to lead healthy lifestyles, by the Health Ministry and concerned Non Government Organisations such as, UNICEF and the World Health Organization (WHO). The result? A large number of elders now walk the streets without even knowing they have diabetes, which exposes them to heart attacks, strokes, blindness and kidney failure. Diabetes affects almost all of our organs. The worst aspect of the disease is that once a person gets diabetes he/she cannot be cured.
However, with controlled diets and disciplined lifestyles, diabetics can lead a good life. The key, as health officials have pointed out, is eating less sugar and sweetened beverages, less carbohydrates, more food high in fibre, more vegetables, and less animal protein. For non diabetic elders, prevention is by avoiding high sugar and salt consumption which causes hypertension, and giving up alcohol and smoking which further jeopardises their heath.
The Sunday Observer spoke to the Director of the Non Communicable Diseases (NCD), Dr T. Siriwardene, to get more insights into how our fast growing elderly population set to reach 25% by year 2050 can protect themselves from NCDs and control them if they are already afflicted by them.
Excerpts…
Q. Sri Lanka has one of the fastest growing aging populations in the Asian region. What is the theme of this year’s Nutrition Month with regard to the health of our elderly population?
A. “Taste without Sugar”
Q. Is this theme relevant to the elderly in particular, or to all adults, young and old alike?
A. To all.
Q. Does it apply to a particular non communicable disease (NCDs) in particular, like diabetes, or to all NCDs in general?
A. Sugar is a causative factor for all main NCDs in general.
Q. Of all the NCDs prevalent in our country, which of them are most common?
A. Heart attack, Brain attack, Cancer, Diabetes
Q. Has there been a national study on NCD prevalence in Sri Lanka or have these figures been arrived at by just controlled studies in a few districts? If so when and where? Who were the targeted population?
A. National NCD Risk Factor surveillance, Indoor Morbidity and Mortality Register, Registrar General Department data etc. are used
Q. Although NCDs are usually considered diseases of the elderly, some health professionals have been quoted as saying that younger persons are now being admitted to hospitals with cardiovascular problems, acute diabetes, stroke, kidney failure. Your comments.
A. Age, sex, heredity and ethnicity are non modifiable risk factors of NCD. Even though the prevalence of NCD goes up with age, NCDs are not diseases of the elderly.
You are prone to get NCDs at any age. The age you get NCDs is reduced with time. Therefore, more younger people get NCDs than in the past.
Q. What is the age group of the people you now see admitted in patients’ wards with various NCD’s? How does this compare with say, a decade ago?
A. The average age of admission due to an NCD has gone down than it was a decade ago.
Q. What is the main or one of the leading causes for this early onset of NCDs in younger people? What is the usual age when such diseases are seen in elderly people – over 60? 65? Is it over consumption of sugar? Unsaturated fats and starchy, oily foods? Drinking sweetened beverages?
A. All four main Risk Factors and Stress plays a role in NCDs. Tobacco consumption, alcohol, lack of exercises, unhealthy diet are the main risk factors of NCD. Over consumption of sugar, salt, fat and especially, trans-fat, including the increased use of carbohydrates play a role in NCD
Q. What is the recommended daily sugar requirement for an adult?
A. The best would be not to have any added sugar in their diets. But, if you need to add sugar to your tea, keep it below 30 grams (6 teaspoons) per day is better.
Q. Is this the recommended dosage by the World Health Organisation or do you have a separate set of guidelines for Lankans?
A. This is the approved maximum quantity by the WHO.
Q. In your experience, do Lankans adhere to these guidelines?
A. No. The average consumption of sugar according to studies is above 60 grams per day.
Q. What are the adverse impacts of too much sugar in one’s diet on 1) adults 2) children?
A. Obesity and Overweight, High Blood Sugar, High Blood Pressure and High Blood Cholesterol can be observed in both, adults and children.
Q. With regard to children it was recently claimed by the Health Ministry sources that more that 13%of schoolchildren, some below 12 years have been diagnosed as pre diabetics. How did this happen? Is being obese and overweight a cause?
A. Heredity, a non-modifiable risk factor, and mainly unhealthy dietary habits and sedentary lifestyle and others have caused this issue. Obese and Overweight are due to exposure to those risk factors.
Q. What are the symptoms to look for in pre diabetic children? A. The main symptom is “no symptom”. They are pre diabetic and not diabetic. Children with a family history of Diabetes, Obese, Overweight and those who consume unhealthy food excessively and live a sedentary life should be investigated to detect them.
Q. How do we know we are obese and overweight? Is there a difference between obesity and being overweight?
A. Yes, you have to measure BMI to decide on Obesity and Overweight. Your doctor, especially, in Health Lifestyle will help to decide on this and advice on further management.
An adult will become Overweight with increasing body weight before he/she becomes Obese.
Q. How can we prevent or minimize falling victims to diabetes?
A. Have a healthy lifestyle. With a tobacco and alcohol free life, consuming a healthy diet, living a physically active life, maintaining good mental health status could prevent or postpone the age you get Diabetes.
Q. What are the inputs by the Health Ministry to reduce diabetes?
A. Raising awareness on how to prevent diabetes and control it, the importance of controlling tobacco and alcohol use, working with other partners and stakeholders to prevent NCDs, Assessment of Cardiovascular Disease risk status in Healthy Lifestyle Centers and necessary advice, School health program, Maternal and Child care, Adolescent health clinics, etc
Q. What role do parents play in helping children to avoid getting early diabetes?
A. Allow children to play. They need to be physically active for at least a few hours a day. Playing on mobile, tab, PC or laptop is not physically active. Do not make children have stress in their life through unnecessary pressure on education.
Q. The Health Ministry has also established Healthy Lifestyle Centres (HLC) in different parts of the country. What are the benefits for adults, including senior citizens?
A. HLCs are for healthy people. If they are ill, they can get treatment from any hospital or a dispensary in the country. Therefore, we expect them to visit HLCs free of charge. All necessary advice regarding prevention and control of NCDs will be provided there. Some centres are providing practical lessons also.
Q. In 2015 the Government decided to display colour codes for beverages using the Traffic Light system. What about food? Recently, the Heath Minister has been quoted as saying that the Ministry hopes to extend the colour code to food items as well. Your comments?
A. Colour coding is a warning message. It tells consumers at a glance if the beverages have high, medium or low amounts of sugar. Red means the drink is high in sugar and warns the public to exercise caution and make an informed choice when purchasing such items.
Q. Will the Health Ministry extend this Code to other food items such as, biscuits, buns and milk products?
A. The Ministry plans to extend the Code to all other foods.
Q. Your Ministry has often referred to a healthy food plate as being the cornerstone for good health. What is a healthy food plate?
A. Due to the very high consumption of carbohydrates, the excessive use of salt and fats and low consumption of vegetables and proteins, our Ministry has developed a special healthy plate for Lankans to gradually persuade them to eat less carbohydrates, more fibre, less salt and sugar and more vegetables and proteins.
Q. What is the average consumption of carbs per serving at preset in the Lankan diet?
A. 70% of rice and only 30% of vegetables, high fibre and proteins. If they can bring down their carbohydrates to at least 50 % it will be an achievement. But it will take time and a change in their mind set and lifestyle.
Q. Is consumption of less vegetables seen more in urban homes than in rural homes?
A. It is more in urban homes because most urban households have no space for home gardens as in rural areas where even the poorest household can live off their land .
Q. In the case of elders, do you recommend additional vitamins such as calcium rich foods to prevent osteoporosis improve their memory, , and vitamin A and D rich foods for better vision ?
A. Yes, most elders do need vitamin supplements along with their diets. They also need sunlight for vitamin D.
Q. Are there any golden rules to follow with regard to the nutrition of elders? What are the reasons for poor heath in elders? Poverty? Wrong diets?
A. Just follow the advice already given. Also, exercise according to their ability. As for poverty being a cause I should reiterate that it is mostly an urban issue as most rural homes live from plants they grow in their home gardens. Again, while elders living in villages work in fields and are exposed to sunlight, it is the elders in urban areas who travel in vehicles and are much less exposed to natural sunlight, who are more vulnerable to lack of vitamin D.