All posts by : Dr Manal Ghazzawi

I think by now most of us know what diabetes is, symptoms, risk factors, complications etc. Most of us think of diabetes, we only associate it with sugar and foot amputations. The American Diabetes Association newest guidelines recommend that screening for diabetes should start as early as 35 years old, compared to 45 years old which was the recommended age in older guidelines. Why is that? This is because of the increased rate of obesity and diabetes globally, both occurring at a younger age. Screening at an earlier age can help identify individuals with abnormal glucose regulation, promote an early start with preventive care and may reduce risk of the multiple complications following the onset of diabetes. It is important that we all assess our risks of developing diabetes by using a diabetes risk calculator available online.

It makes me happy to see more people engaged in physical activity when I take a walk at the beach. We need to include exercise as a vital component in our lives, take it as seriously as our religion. Many international health organizations recommend that individuals must engage in at least 150 minutes of exercise per week, exercise that involves all major muscle groups to prevent diabetes. This recommendation is also vital for diabetic patients where they should not go for more than 2 days with no exercise. 

Exercise helps prevent complications of diabetes by controlling weight, lower blood pressure, lower harmful LDL cholesterol and triglycerides, raise healthy HDL cholesterol, strengthen muscles and bones, reduce anxiety, and improve your general well-being. Exercise also improves the action of insulin among diabetic patients. 

Obesity is a major cause of diabetes, heart disease, stroke, and cancer. Africa is facing a growing challenge of obesity and overweight and trends continue to rise. Obesity rates are higher north of the Sahara and in Southern Africa. In Western Africa, the great news is obesity rates are still not very high, but slightly higher than Eastern Africa and the interior. Our dietary habits such as consuming energy-dense foods, lack of physical activity associated with rising urbanization or changing modes of transport are significant drivers of obesity globally. Lack of strong policies in key sectors including health, agriculture, urban planning, and environment to support healthier lifestyles also contributes to growing rate of non-communicable diseases which we neglect in our society. 

In Sierra Leone, if you go to the local food market most of what is there is healthy and highly nutritious, the issue lies on how we use those foods to prepare our meals. Let us forget about going to the supermarket to buy expensive imported foods that are “considered healthy”. Focus on eating natural foods that have not been tampered with by humans! There are many foods at the store with labelled hidden sugars which we should be aware of. There are misleading food advertising labels like ‘sugar free’, light/fat free’ but still considered junk food! Always read your nutrition labels at the back! 

Diabetic patients I manage have this mindset that eating healthy can be expensive, it is quite the opposite. Here are some tips to help you eat healthily on a budget:

1. Shop smart, plan and make a list of healthy foods you can stick to in the supermarket or local market.
2. Use the fresh fruit and vegetables you already have at home first, before buying more.
3. Meal preparation means you can buy and cook in bulk, which will save you both time and money.
4. Only buy what you need.
5. A tip I give to myself is “Never go to the supermarket when you are hungry”.

Back to our main topic, here are the hidden side effects and sweet danger of sugar! Apart from weight gain and diabetes, excessive consumption of sugar causes bad skin (sagginess and wrinkles), depression, drains your energy, dementia, and Alzheimer’s disease, joint pain, fatty liver, heart disease. 

My key message today in commemoration of World Diabetes Day is to include regular physical activity as your lifestyle, as an obligation you owe to your mind and body, know what a healthy food/ meal consists of and make a change today, let us cherish and respect our body.

Hepatitis is an inflammation of the liver commonly caused by viral infection. There are five main  hepatitis viruses, referred to as types A, B, C, D and E. Every 30 seconds, someone dies from a  viral hepatitis related illness. The disease can affect anyone, but underserved communities are  disproportionately affected. Chronic hepatitis B and chronic hepatitis C are among the life threatening infectious diseases that cause serious liver damage, cancer, and premature death. 

Chronic hepatitis B and chronic hepatitis C are neglected, silent infectious diseases with a  burden that has surpassed malaria, human immunodeficiency virus (HIV) and tuberculosis (TB)  in Africa. Globally, 354 million people are living with the hepatitis B or C virus. According to African  Center for Disease Control and Prevention, the African region has the highest of hepatitis B,  where 82.3 million persons are living with chronic hepatitis B. Two of every three children infected  with hepatitis B globally are born in Africa and hepatitis B infection acquired at birth or in early  childhood is the most common cause of primary liver cancer in adulthood. In Sierra Leone,  according to a recent meta-analysis by Yendewa et al [1], 1 out of every 8 persons is infected with  hepatitis B, which means approximately 1 million Sierra Leoneans have chronic hepatitis B  infection.  

Millions of people living with hepatitis B face an added burden of stigma and discrimination.  Stigma is defined as a social process, experienced, or anticipated, and which is characterized by  exclusion, rejection, blame, or devaluation resulting from experience, perception, or reasonable  anticipation of an adverse social judgement about a person or a group [2]. Studies confirm key  underlying reasons for stigma included fear of infection, as well as negative assumptions and  stereotyping around the sources of infection, with hepatitis B transmission in adults often being  perceived as associated with the use of injectable drugs, sexual promiscuity, or homosexuality. 

Stigma resulting from hepatitis B infection has contributed to discrimination, a reduction in  quality of life, and difficulty accessing employment, education, and immigration. Studies have  been done to confirm the psychological responses to discrimination which include trauma,  suicide, mental health challenges, depression, economic instability, and social isolation. People  living with hepatitis B go through extreme poverty as they must pay out of pocket to manage their  life-long disease. Many young Sierra Leoneans who have ambitions to travel abroad to study or  seek greener pastures have been refused a visa after an unknown positive status was revealed to  them. Young aspiring individuals are stripped off great job opportunities in Sierra Leone, because  of their hepatitis B positive status. 

Lack of knowledge about the mode of transmission results in unnecessary stigma and  discrimination. So let us debunk some of the myths and misconceptions surrounding this silent  killer virus. Hepatitis B is not transmitted through casual contact, neither through sharing of food  nor kitchen utensils. Many reports have shown that even people living with hepatitis B have poor  understanding of the mode of transmission of the infection which can result to internalized  stigma. It is sad to witness a parent scared or have a sense of guilt to transmit the virus to their 

children. If we think about it, what can a poor man in a village, or an uneducated person know  about the disease if he can’t read? Thus, the importance of community outreach programs  should never be underestimated. Notwithstanding this, even educated people do not know much  about HBV infection and its mode of transmission. 

Household transmission of the virus, which is a form of horizontal transmission, can occur  through blood-to-blood contact from an open wound of an infected person or through sexual  contact. Therefore, it is very important to disinfect surfaces that have been contaminated by  blood and to keep wounds covered. Other than that, parents can hug, play, kiss their children and  eat together. Notwithstanding that, sharing of toothbrushes, nail clippers and razors can lead to  transmission of hepatitis B. It is however crucial for household members to be vaccinated.  Children can transmit the virus to each other through wounds or bites but not through tears,  sweat or urine. However, if a child has been immunized against the virus, this form of transmission  rarely occurs. 

In a first published study in Sierra Leone by Ghazzawi et al [3], on assessment of stigmatization  attitudes, 43.5% of the participants had concerns with sharing food or utensils with someone  with hepatitis B. Similarly, 44.1% stated that they would have concerns with having casual  contact or working with a person known to have hepatitis B. Overall, nearly half (49.3%) expressed  at least one stigmatizing attitude towards people with hepatitis B.  

A big misconception in Sierra Leone about the mode of transmission of hepatitis B is that people  believe it is transmitted through sweat, one big myth that needs to be demystified. According to  Ghazzawi et al [3], almost 68% of people believed hepatitis B is caused by a curse or evil spirit.  This underscores the need for educational interventions at all levels of society to dispel myths  and misconceptions by embarking on community awareness raising and sensitization.  Community education and mobilization campaigns related to hepatitis B vaccination are critical  to preventing CHB infection and reducing stigma and discrimination toward people living with  hepatitis B. 

Disclosure of positive hepatitis B status to sexual partners and family members remains a major  challenge for people living with hepatitis B. I have come across lived experiences of people living  with chronic hepatitis B whose partner and/or family member have abandoned them because of  their status. A handful of Sierra Leoneans are very hesitant to disclose their status to their  partners, especially when we know practicing a polygamous relationship is a way of life and a  culture in our society, keeping a positive status of the virus a secret and continuation of practicing  unprotected sex with partners can results in a chain reaction of transmission of the virus.  Remember that symptoms of hepatitis B infection appear after 9-21 weeks of exposure to the virus. 

According to Ghazzawi et al., assessment of health-seeking behaviors by the public, yielded  overwhelmingly positive results, where 80.4% were willing to take medication for treatment if they  tested positive for hepatitis B, while a similar proportion (78.8%) were willing to undergo regular  clinic follow up every 3 to 6 months for the management of hepatitis B. This study shows that  people are willing to seek healthcare if the environment is conducive to do so and having health  care professionals with adequate knowledge to offer the dire need for appropriate healthcare  services and psychosocial support. Studies in SL have demonstrated poor knowledge of hepatitis  B infection among healthcare professionals.

Although data does not exist in Sierra Leone to elucidate this, there are studies done in other  countries which reveal that healthcare professionals themselves contribute to stigma and  discrimination among people living with hepatitis B. hepatitis B-related stigma and  discrimination result in low uptake of hepatitis B education, screening, immunization, and sound  preventive practices among at-risk individuals, underscoring the importance of effective  hepatitis B education among healthcare professionals. 

Now that a hepatitis policy exists for the first time in Sierra Leone, we are eagerly waiting to see  government take swift actions towards providing dignified and equitable services to those living  with hepatitis B and to deliver effective prevention strategies and health promotion programs to  eliminate the virus by 2030! An ambitious target which all countries with high burden of the  disease have set as a target for elimination. 

Sadly, there are no anti-discrimination laws and policy in Sierra Leone to protect the rights of  Sierra Leoneans affected with hepatitis B. Eliminating the stigma surrounding hepatitis through  the introduction of policies and structural changes has been named as a key factor in hepatitis  elimination by the World health Organization. Policy makers and decision-makers have an  essential role in ensuring that anti-discrimination laws, public health policy, education and  health systems work together with civil society and the affected communities to tackle the crisis  of stigma and discrimination. To address these challenges, and as KnowHep Foundation is a  professional body that advocates for elimination of VH in Sierra Leone, in collaboration with the  World Hepatitis Alliance, we urge government to adopt the following policies:  

1. Provide accurate and accessible information regarding hepatitis B for those newly diagnosed  including transmission, health promotion information, rights and responsibilities, and long-term  health plan. 

2. Ensure all newly diagnosed individuals are linked to appropriate and supportive healthcare  services for ongoing monitoring and management. 

3. Ensure equitable and affordable access to prevention of mother-to-child transmission (PMTCT)  programmes for all women. 

4. Ensure that mental and emotional support is provided to people diagnosed with hepatitis B  and their families. 

5. Require that all healthcare professionals receive ongoing hepatitis education and are aware of  stigma and how to address it. 

6. Ensure testing for hepatitis B is conducted in the context of healthcare services, that the results  are confidential, that the testing is of direct benefit to the person being tested and is not required  as a condition of employment or education. 

7. Anti-discrimination laws and policies must be formulated, and correctly implemented, and  adequate recourse is given to enable people experiencing discrimination to pursue justice  through the legal system. 

8. Ensure there are legal protections in place for people with hepatitis B, including protection from  government sanctioned discrimination. 

9. Ensure that immigration and visa policies do not limit the freedoms of people living with  hepatitis B, because of their diagnosis.

10. People living with hepatitis B should have their voice heard. Sharing lived experiences will  reduce stigmatization. People living with hepatitis B must come forward to report any form of  discrimination against them and they have the power to drive political will. 

Despite the availability of hepatitis B medication and a vaccine, many people living with hepatitis  B in Sierra Leone are still unable to access or afford the treatment and preventative measures  they need. The poor people are left alone to tackle the epidemic. Policy makers must act now to  improve the lives Sierra Leoneans who are currently impacted by hepatitis B. We are NOT  WAITING, and we cannot leave people behind. The lives of people living with hepatitis B are  impacted by stigma and discrimination every day. Their human rights must be protected. With  concerted effort we can end stigma and discrimination and improve the lives of people affected  by hepatitis B in Sierra Leone. 

Below is a brief list of resources for people living with hepatitis B or individuals living with people living with  hepatitis B. 

1. Transmission of hepatitis B – how hepatitis B can be transmitted. 

2. Online Support Groups 

3. Factsheet – When Someone in the Family has Hepatitis B 

4. Know Your Rights – for anyone experiencing discrimination because of their hepatitis B status 

References 

1. Yendewa GA, Wang GM, James PB, Massaquoi SPE, Yendewa SA, Ghazzawi M, Babawo LS, Ocama P,  Russell JBW, Deen GF, Sahr F, Kabba M, Tatsuoka C, Lakoh S, Salata RA. Prevalence of Chronic Hepatitis B  Virus Infection in Sierra Leone, 1997-2022: A Systematic Review and Meta-Analysis. Am J Trop Med Hyg.  2023 May 22;109(1):105-114. doi: 10.4269/ajtmh.22-0711. PMID: 37217165; PMCID: PMC10323991. 

2. Martin N., Johnston V. A Time for Action: Tackling Stigma and Discrimination. Mental Health Commission  of Canada; Ottawa, ON, Canada: 2007. [Google Scholar] [Ref list] 

3. Ghazzawi M, Yendewa SA, James PB, Massaquoi SP, Babawo LS, Sahr F, Deen GF, Kabba M, Ocama P,  Lakoh S, Salata RA, Yendewa GA. Assessment of Knowledge, Stigmatizing Attitudes and Health-Seeking  Behaviors Regarding Hepatitis B Virus Infection in a Pharmacy and Community Setting in Sierra Leone: A  Cross-Sectional Study. Healthcare (Basel). 2023 Jan 6;11(2):177. doi: 10.3390/healthcare11020177. PMID:  36673546; PMCID: PMC9859485.

Why is sunlight so important to the human body?  

Let’s go to the cellular level, every cell in our body has a mitochondrion which is the machinery or  powerhouse in our body that produces energy. The mitochondria take the food that we eat and  transform it into energy. However just like every machine it can overheat, shut down and produces a  byproduct called oxidative stress which are oxygen radicals! When oxidative stress builds up too much, it can cause lots of problems that could lead to less optimal health causing inflammation, cancer,  dementia, diabetes, learning disabilities and even Covid-19 mortality. When oxidative stress builds up  in the mitochondria, there’s a cooling system which occurs day and night. There is a fascinating  chemical which is activated to be produced to reduce oxidative stress in the mitochondria, interesting  right? This chemical is called melatonin (see figure 1), produced in our brain both at night and during  the day, it is one of the strongest antioxidants, twice as potent as vitamin E.

Figure 1. The Importance of Melatonin Against Oxidative Stress 

According to a published paper in 2019, by Professor Scott Zimmerman, it was highlighted that  melatonin produced in the mitochondria to reduce oxidative stress, may play a role in the prevention  and/or treatment of Alzheimer’s and Parkinson’s disease (see figure 2). 

Figure 2. View of Melatonin and the Optics of the Human Body 

At night melatonin is produced in the brain, enters the blood stream, and then goes into every cell of  our body to mop off the oxidative stress produced by the mitochondria. We can say this is how the  body gets rid of oxidative stress at night and we are able to sleep. Any form of light at night, exposed  to our eyes can shut down melatonin production from the brain. During the day, there is a completely  different system that stimulates the production of melatonin to combat oxidative stress. At daytime, 

melatonin production in the mitochondria is stimulated by near infra-red radiation (NIR) from the sun.  This is a new scientific discovery which makes us rethink, as to how much sunlight we are getting, and  what happens if we don’t get enough?! It is important to understand that melatonin produced by our  brain at night (Hormone of Darkness) helps us sleep, and the melatonin produced at cellular level  inside the mitochondria, this is stimulated by sunlight (hormone of daylight) play different roles – which has nothing to do with sleep at all! Mind you the above effects do not occur with melatonin  supplements that you might be taking, melatonin supplements just go directly to your blood stream  and tell the body to sleep.  

How do humans interact with light?  

One way we can explain our interaction with light is through the circadian rhythm (CR). CR is a 24-hour  cycle that is part of the body’s internal clock, running in the background to carry out essential functions  and processes. The CR regulates our body temperature (figure 3), helps in production of melatonin,  and many other chemicals that are essential for our body functions. According to the CR, melatonin  production starts at 9 pm and that is the time you would want to avoid bright light exposures to  prevent shutdown of melatonin production. Consequently, is it very important that the CR is in sync, and it is well regulated. There is scientific evidence to prove that dysregulation of the CR, can cause  induced sleep-wake misalignment which in turn can cause unscheduled production of insulin and  other hormones, circadian misalignment due to sleep deprivation can induce production of  inflammatory markers and insulin resistance which is a main culprit in type 2 diabetes (Scheer et al.). Disruption of the CR can cause stress hormone production at a rate which can be associated with  anxiety and depression during the day.  

Figure 3. The Circadian Rhythm 

One way to allow the CR to align with what goes on outside your body and to help you sleep at night  is by avoiding screen time or bright lights during bedtime, as this could shut down the production of  melatonin and leads to insomnia. In other words, avoid using laptops, phones at the time you are  supposed to be sleeping. If you need to work at night with your laptop avoid screen time at least 2  hours before bed. In addition, if you are awake before bedtime, it is inevitable that you need some 

lighting but let it be low on the floor below your visual field and as dim as possible. Orange or red dim  light below your visual field could also be better if you need to have light in your room. 

Why should we be happy with West Africa’s sunny weather?  

If you have lived abroad in a country long enough during winter, you will learn to appreciate and long  for sunny weathers. You will appreciate sunlight even if it is freezing cold, you will feel rejuvenated to  see the sun shining bright while you are outside. The sun elevates your mood, for this reason people  experience seasonal affective disorder during the winter season, and women are more prone to be  depressed during winter than men according to studies. In a meta-analysis, it was proven that  exposure to bright light during the day between 15 minutes to an hour for 4 weeks improved mood,  hence reduced seasonal affective disorder (SAD) Figure 4. 

Figure 4. Mechanism of action of Light Therapy in patients with SAD 

To anchor the circadian rhythm or to set it right, NIR sunlight exposure should be done before 9am in  the morning ranging between 30 sec to 30 mins. Wearing sunglasses will limit kickstarting the CR  accordingly. The brighter the sunlight the shorter time you need to spend outdoor, if it is a cloudy day up to 30 mins exposure will be needed. NIR penetrates your clothes deep into the skin/body and can  be perceived as heat. Sunscreens can only block ultraviolet radiation but not NIR. When we say  sunlight exposure, sitting in your car driving somewhere does not count, it is about really getting  outside in the open; direct sunlight exposure I mean. Notwithstanding that, interestingly, you can still  be in the shade and get NIR exposure because leaves of trees reflect the latter. Sunlight exposure is  safest before 10 am and after 3pm. The more time spent under direct sunlight the more Vit D will be  produced by the skin through ultraviolet B (UVB) radiation (Figure 5). 

Figure5. The Solar Spectrum 

Environmental research published in 2018, demonstrates that spending time and living close to  natural green spaces reduces the risk of type2 diabetes, cardiovascular diseases (heart and blood  vessel diseases) and premature death. People living closer to nature have reduced blood pressure,  heart rate and stress. Exposure to light or sunlight improves subjective wellbeing, cognitive  performance, reduces depressive disorders and cancer. In fact, the World Health Organization  classifies CR disruptive work shift, as a probable carcinogen (cancer-causing agent). 

To cut matters short, go for a walk every morning, enjoy mother nature’s sunlight while you can, to  live a healthy and prolonged life! Rely on sunlight to naturally produce melatonin, get your CR on sync to help you sleep like a baby!

Ramadan is a sacred month eagerly anticipated by Muslims around the world. It brings immense joy and peace into our lives when observed, promoting overall well-being for both our minds and bodies. Research has shown numerous health benefits associated with fasting:

1. Improving verbal memory
2. Improves heart health by reducing blood pressure, resting heart rates and other heart-related measurements
3. Exercising when fasting enhances physical performance, more fat loss and maintenance of muscle mass
4. Fasting can help people that are obese to lose weight and people with diabetes (with strict supervision) to control their sugar level- helping to get off insulin therapy.

While fasting can be beneficial for individuals with diabetes, it is important to be aware of the associated risks and complications. It is crucial to approach the holy month with caution to avoid hypoglycemia (low blood sugar levels) or hyperglycemia (high blood sugar levels), dehydration, or diabetic ketoacidosis (liver breaks down fat for fuel). Prior to beginning fasting, it is essential to engage in advanced planning with your healthcare team.

Individuals with well-controlled type 2 diabetes who effectively manage their condition through a healthy lifestyle and medication regimen can fast by adjusting their medication and regularly monitoring their glucose levels with their healthcare team. However, those with diabetes who are fasting and taking high doses of medication, as well as engaging in physical activity, should exercise extreme caution to prevent hypoglycemia.

People who may be at high risk of complications when fast during Ramadan include the following:

• Type 1 diabetes
• Type 2 diabetes with poor blood sugar control or taking certain types of insulin
• Recent history of severe low blood sugar or diabetic ketoacidosis
• History of recurring low blood sugar or unawareness of low blood sugar
• Conditions such as severe kidney disease or blood vessel complications
• Diabetes and is pregnant

The expected values for normal fasting blood glucose concentration in a diabetic patient are 4-7 mmol/L (72mg/dL- 126mg/dL) and below 8.5 mmol/L (153mg/dL) at least 90 mins after eating. 

It is crucial to understand that individuals may react differently to varying levels of low blood sugar. Therefore, it is essential to closely monitor your glucose levels and educate your family members on recognizing signs of low blood sugar, which may include, irregular or fast heartbeat, fatigue, pale skin, shakiness, anxiety, wearing, hunger, irritability, tingling or numbness of the lips, tongue, or cheek

As low blood sugar progresses, symptoms can worsen and may include confusion, abnormal behavior, or both. These symptoms may manifest as the inability to complete routine tasks, visual disturbances like blurred vision, seizures, or loss of consciousness.

If you experience any of the aforementioned symptoms, immediate treatment is necessary. 

1. Eat or drink 15 to 20 grams of fast-acting carbohydrates. These are sugary foods or drinks without protein or fat that are easily converted to sugar in the body. Try glucose powder, fruit juice, regular (not diet) soda, honey, or sugary candy.
2. Recheck blood sugar levels 15 minutes after treatment. If blood sugar levels are still under 70 mg/dL (3.9 mmol/L), eat or drink another 15 to 20 grams of fast-acting carbohydrate, and recheck your blood sugar level again in 15 minutes. Repeat these steps until the blood sugar is above 70 mg/dL (3.9 mmol/L).

3. Have a snack or meal. Once your blood sugar is back in the standard range, eating a healthy snack or meal can help prevent another drop in blood sugar and replenish your body’s glycogen stores.

Additionally, to prevent hyperglycemia, it is important to be prepared to adjust medication doses, regulate food intake, and be willing to break your fast if needed.

What is best to eat during Iftar?

1. Eat few dates, they are high in fiber, calcium, iron – rich in potassium
2. Complex carbohydrates such as whole grains like lentils, quinoa, bulgar wheat, brown rice, millet, wheat etc
3. Protein-rich sources such as lean meat, skinless chicken, fish, eggs, legumes and low-fat dairy products.
4. Avoid deep fried foods and those with refined carbs like white bread, pastries, biscuits etc. Instead, break your fast with like salads and vegetable soups, then later citrus fruits after your main meal.
5. Reduce the intake of salt and salted food, such as dressing, sauces, salted nuts and crisps. Dehydration is a risk due to limited fluid intake during the day, and high salt foods can further increase this risk.
6. Drink plenty of water at Suhoor and Iftar. It is recommended that you drink at least 8 cups of water between Iftar and Suhoor so that your body may adjust fluid levels in time for the next day.

Avoid drinks that contain caffeine such as tea and coffee as these can make you lose more water by going to the toilet more. Avoid sugary drinks such as orange, apple, tropical fruit juice and fizzy drinks. Diet drinks and non-sweetened drinks are preferred options.

In conclusion, it is important to remember that while the Qur’an mandates fasting for Muslims during the month of Ramadan from dawn to dusk, it also emphasizes the importance of not harming one’s body. Individuals living with diabetes and other health conditions may be exempt from fasting due to the increased health risks involved.

I extend my warm wishes to all in advance for a blessed Ramadan and Eid al-Fitr.

We’ve been told that, eat 3 meals a day, with snacks in between, or 5 small meals a day to boost your metabolism, and that putting your body on starvation mode will slow down your metabolism and losing weight will backfire at you if you reduce your number of meals daily. In fact, intermittent fasting (IF) increases your metabolic rate, it is now the key to losing excess weight, having good health, mind, and body. This reminds me of the holy Quran, most of what is mentioned for us to be engaged in, is for our own good. The prophet Mohamed has always been fasting twice a week, and now evidence points out to the benefits of IF. During the holy month of Ramadan, our 14 hours fasting is literally a form of the modernized way of saying IF. 

What is intermittent fasting?

Our body is made to strive for a longer period without food, it is made to do the right thing just at the right time. IF can mean eating for 8 hours and fasting for the remaining 24-hour period or fasting for 20 hours and having 4 hours window period. It could also mean eating one meal a day every day or twice a week. Consistency is key when engaged in IF. I hear most people say, “I stop eating after 7pm till the next morning”, which is also a form of IF. Studies have shown that fasting for 16 hours kickstarts burning of stored fat, meaning it takes 16 hours for your body to consume calories that you have ingested before, for it to start burning excess fat stores, especially in the belly area. Try to avoid eating 3 hours before going to bed.

Strategies to losing belly fat through IF.

Before we dive into strategies to lose weight, let us first know the different types of fat, we have the subcutaneous fat, which is the fat underneath our skin and the visceral fat which is the fat wrapped around our organs. People have this false belief that abs exercise can help burn belly fat, it is through fasting that belly fat can be minimized. However, cardio exercise can help you lose belly fat, especially subcutaneous fat. 

The first thing you need to realize is that fat is excess sugar, excess hormones, or toxins. Hence, if you want to lose belly fast, you can adopt the above IF schedule but to be mindful of what you eat and how much you eat. When breaking your fast, the first step is to eat high fiber and clean protein foods, to keep your insulin levels low. Eat green leafy vegetables, foods with probiotics and healthy fats like avocados. Avoid inflammatory fats like canola oil, sunflower oil, corn oil, vegetable oil and soybean oil. In addition, avoiding all processed food, eating natural carbs is the best way to achieve healthy goals apart from losing weight. 

Practicing mindfulness can also help reduce belly fat indirectly because it reduces or prevents production of the stress hormone cortisol. Cortisol production spikes up in the morning after waking up, hence it is best to go for a walk within 2 hours after you wake up. Stressful jobs or situations can also increase your cortisol levels, which translates to increased belly fat if you do not exercise, sitting on a chair the whole day at the office. 

Intermittent fasting mistakes that make you gain weight.

1. Not varying your fast, i.e., not adopting different schedules of IF but just sticking to one. It is also important to take breaks during IF for like a week or two.
2. Not fasting long enough
3. Not eating the right foods and binge eating

Intermittent Fasting Benefits

1. IF helps to reduce insulin levels, increases levels of growth hormones which help in fat burning process. 

2. Helps in gene expression which is related to prevention of certain diseases that lead to inflammation or cancer.

3. IF also helps in cellular repair i.e., removing toxic wastes from cells.

4. Can help you lose weight and increase physical performance.

5. Lowers risk of type 2 diabetes mellitus (T2DM) and helps reduce insulin resistance in T2DM. Studies have shown that people with T2DM who fast under their doctor’s supervision, have better glucose control and were able to reverse the need for insulin therapy.

6. Lowers blood pressure, bad cholesterol, and inflammatory markers.

7. May help prevent Alzheimer’s disease as it improves verbal memory.

Is intermittent fasting safe?

IF is safe for most people but not for everyone. If you are pregnant and breastfeeding you should not do IF, or if you have kidney stones, gastroesophageal reflux, type 1 diabetes, or other medical problems. Speak to your doctor before starting IF.

If thou wouldst preserve a sound body, use fasting and walking; if a healthful soul, fasting and praying; walking exercises the body, praying exercises the soul, fasting cleanses both. ~Francis Quarles

26^th June 2024 marks the international day against drug abuse and illicit trafficking, a topic worth to have a spotlight on, as Sierra Leone is currently facing a pressing public health crisis as the prevalence of illicit drugs, notably Kush, continues to rise alongside an alarming increase in Hepatitis B incidence.This dual challenge poses significant threats to the health and well-being of the population, as well as the societal fabric of the country. Understanding the complexities of these interconnected issues is crucial in developing effective strategies to mitigate their impact and prevent further escalation of the crisis.

According to a study in sub-Saharan Africa, an estimated 95% of individuals with chronic HBV or HCV infection, or both, are unaware of their infection and so do not benefit from clinical care, treatment, and interventions that are designed to reduce onward transmission.

Risk Factors Contributing to The Prevalence of Hepatitis B Within Drug-Using Populations

Hepatitis B/C is like that unexpected guest who never leaves, and it is not the kind of guest you’d want crashing on your liver’s couch. Hepatitis B/C are viral infections that target the liver, causing issues ranging from mild illness to serious problems like liver cirrhosis, chronic liver disease including liver cancer. Drug users and Hepatitis B/C seem to go together and not in a good way. The prevalence of Hepatitis B/C among drug users is alarmingly high, making it a major concern in this community.

From city streets to remote corners of the world, Hepatitis B/C doesn’t discriminate – it’s making itself comfortable among drug users worldwide. Whether you’re in the bustling city or a quiet town, the risk is real for those who choose to play with fire.

Sharing needles isn’t just a red flag for hygiene; it’s practically rolling out a welcome mat for Hepatitis B/C. Injecting drugs puts you at a higher risk of spreading and contracting the virus, turning a needle into a risky business card. Unprotected sex and other high-risk behaviours increase the chances of transmission, making it easier for the virus to crash your liver’s party.

Effect of Substance Abuse on Hepatitis B/C Disease Severity

Illicit drug use mixed with alcohol and being infected with Hepatitis B/C is like throwing gasoline on a fire – it can intensify the severity of the disease and complicate treatment. Substance abuse can turn a manageable situation into a full-blown liver drama, making the battle against Hepatitis B/C an even tougher one.

Challenges in Hepatitis B/C Prevention and Treatment for Drug Users

Managing Hepatitis B/C among drug users is a challenging task for health care practitioners. From addressing substance abuse issues to ensuring proper medical care, there are hurdles at every turn. But with the right approach and support, tackling Hepatitis B/C in this population can lead to better health outcomes. In addition, barriers like stigma, lack of access to healthcare, and fear of judgment can make it challenging to protect this at-risk group.

Strategies for Hepatitis B Prevention in Drug Using Communities

1. Harm Reduction Approaches

It will be interesting to know how many drug users in Sierra Leone inject drugs, that we do not know. I think people inhale drugs more than injecting. When it comes to preventing Hepatitis B/C in drug using communities, harm reduction approaches play a crucial role. Harm reduction is a set of practical strategies and ideas aimed at reducing negative consequences associated with drug use. Harm Reduction is also a movement for social justice built on a belief in, and respect for, the rights of people who use drugs. Investigating harm reduction techniques that aligns with Sierra Leone’s perspective of illicit drug use could help in easy implementation.

2.     Community Outreach and Education Programs

Educating drug users about the risks of Hepatitis B/C and the importance of vaccination is essential in prevention efforts. Community outreach programs that engage with drug using populations can help raise awareness and promote positive health behaviours.

3.  Addressing Stigma and Access to Healthcare for Drug Users with Hepatitis B

Stigma surrounding drug use and Hepatitis B can create barriers to healthcare access and support for affected individuals. Addressing stigma through education and advocacy is key to ensuring that drug users with Hepatitis B receive the care they need.

4.     Improving Healthcare Access and Support Services

Improving access to healthcare services, including Hepatitis B testing, treatment, and counselling, is vital for drug users with the virus. Providing support services such as mental health care and addiction treatment can also enhance overall health outcomes.

5.     Public Health Implications and Policy Recommendations

The prevalence of Hepatitis B among drug users has significant public health implications, including the potential for outbreaks and increased healthcare costs. Addressing Hepatitis B within drug using communities is crucial for overall disease prevention efforts.

Policy recommendations for preventing and treating Hepatitis B among drug users should focus on increasing access to vaccination, improving healthcare infrastructure in underserved areas, and implementing evidence-based harm reduction strategies.

In conclusion, addressing Hepatitis B within drug users requires a multifaceted approach that combines harm reduction, education, stigma reduction, improved healthcare access, and supportive policies. By working together towards comprehensive solutions, we can make significant strides in preventing and treating Hepatitis B in this vulnerable community.

Dr. Manal Ghazzawi is a clinical pharmacist, CEO of CitiGlobe Pharmacies Ltd and KnowHep Foundation Sierra Leone. She has great passion for writing on health issues afflicted by Sierra Leoneans apart from her contribution in the fight against Hepatis B in Sierra Leone.