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Cashew, avocado and heart patients: scientific explanations
There is more to this heart disease related nutrition says a consultant

Interpretation of Nutrition data is difficult due to various nutrient interactions that take place within the body at metabolic level and also due to difficulties in controlling various confounding factors (health, dietary and socio-cultural factors) that may affect the results of Nutrition Intervention Trials and Nutrition Epidemiological Observations (see section: Something is wrong - para one).

Therefore, interpretation of nutrition data, particularly translating information from nutrition trials and epidemiological data in to dietary advice must be done with caution. Nuts do contain Mono Unsaturated Fatty Acids (MUFA), which are considered heart healthy. However, such foods are never recommended to heart patients or the general population without conditions or limits. The key issue is not nuts or MUFA but the unscientific and irresponsible manner in which scientific information has been distorted and disseminated to a large group of people who are vulnerable to diet related Non Communicable Diseases (NCDs) via the mass media.

The scientific data presented in this article indicate that heart disease, hypertension (high blood pressure), and diseases such as diabetes that predispose an individual to heart disease and stroke are common problems amongst both the rich and the poor of this country today. The important question is that in a back drop such as this, how could heart patients or even healthy people be 'recommended' to consume foods such as fried salted cashew nuts (high in salt and energy) and also other energy dense foods such as nuts or avocado adlibitum (without restrictions). There are different principle of Nutrition and Diet Counseling. When dietary advice is offered at 'individual level' it is crucial to adopt a 'Holistic Approach'. When advice is offered on mass media at 'national level' it is also important to consider the existing health and nutrition situation of the country i.e.: the Nutrition Transition that is taking place in Sri Lanka at present. This article highlights a classic example of a mismatch between the health and nutrition situation of the country and the nutrition and dietary advice offered to the public via the mass media. The above misinformation has created a need to educate the public on the scientific position with regard to the consumption of energy dense foods. This article raises important questions in relation to public health, professional obligations/ethics and media ethics.

Background
I write with reference to Mr. R Wickremasinghe's letter to Dr D P Atukorale (Daily News, Health Watch, 15/11/02) titled Kadju and Cholesterol and Dr D P Atukorale's reply to Mr. Wickremasinghe titled Controversy about Cashew Nuts and Avocado (Daily News, Health Watch, 29/11/02). In his letter Mr. Wickremasinghe (whom I shall refer to as Mr. Wic) states that he is a heart patient who is attending the Cardiology Unit of the General Hospital regularly and when he inquired about the above matter, the doctors from the unit vehemently objected to his consuming cashew nuts, avocado and coconut oil. Mr. Wic queries from Dr Atukorale, as to the basis on which Dr Atukorale recommends heart patients could eat cashew and avocado without any 'reservations' as against the advice of many other doctors. Mr. Wic also had the following to say "It is time that the Medical Council meet and have a discussion on this subject and arrive at a final decision in order to put the mind of the public at rest once and for all, as this controversy has dragged for too long" Interestingly, Mr. Wic also noted that "Something is wrong somewhere". I trust the above quotes highlight the dilemma of the public, particularly, people like Mr. Wic who are affected by heart diseases and need to be given sound dietary advice. Doctors at the Cardiology Unit have used a cautious approach, which is also a very wise approach. It is best to err on the side of caution. As Mr. Wic points out this controversy has dragged on for too long and this is a very sad and unacceptable state of affairs. Indeed, as very rightfully stated by Mr. Wic, something is very wrong somewhere and I shall try to explain to the readers what is wrong. I request the readers also to refer my reply in the Daily News, Health Watch of 13/12/02, Cashew, avocado and heart patients: a reply. It is earnestly hoped that this article will be informative and will help to clear some of the misinformation on cashew, avocado and heart patients.

Points to ponder
However before I go into the scientific details I wish to place some important questions before the public. As explained below, currently the Sri Lankan public is highly confused with regard to many important nutrition related issues that have a major bearing on public health. A heart patient is pleading with the medical community of this country to clear the misinformation but to no avail. In this country of nearly nineteen million people why didn't any one come forward to answer this question? It is important for the public, and the policy makers to find out the answer? It is no secret that many people holding high office in this country; the policy makers, persons from the medical community and people from all segments of the of the society today are suffering from heart diseases or conditions such as overweight, obesity, diabetes, hypertension, etc that predisposes them to heart disease. If you or one of your loved ones are suffering from heart disease or you come from a family with a history of heart disease which puts you at risk of developing the disease what kind of nutrition information and dietary advice would you like to hear on the media? Sensational, selling news or sound, scientific information? Please read the following information carefully and decide for your self.

Dilemma of the public
First and foremost I wish to state why I am entering into this controversy. Mass Media can be used for promoting both positive (i.e.: health education) and negative (the above is one example and also commercial advertising of food products luring the public to eat the wrong kinds of food is another) health messages. In a country like Sri Lanka, nutrition education can play a very positive role in the prevention of diet related Non Communicable Diseases (NCDs)/ diet related chronic degenerative diseases. This author in an article titled 'Preventing non-communicable diseases through nutrition education,' Daily News, 17th May 2002, highlighted this. My discipline compels me to provide up-to-date and timely nutrition information to the Sri Lankan public and therefore I have engaged in educating the general public on important nutrition related issues such as obesity, diabetes, heart disease etc. through print and electronic media and also through other forums.

It is important to note that on most occasions when some incorrect nutrition information or dietary advice was offered on the media, I have had many queries form patients, non-patients and also members of the medical fraternity inquiring regarding their validity. Just like Mr. Wickramasinghe, these are people who were somewhat better informed and felt that there was 'some thing wrong somewhere'. There may be many others who are confused but are unable to find the correct answers. Most importantly there are many, including medical doctors who believed that what appeared in the press was correct. On numerous occasions many medical practitioners, some cardiologists and the general public (particularly patients) have expressed their concerns over the incorrect nutrition information and unsound dietary advice offered to the public through the print media and have requested me to address these issues through the media. However, as evident from this publication, it takes much to undo such misinformation and time was a limiting factor. After seeing Mr. Wickremasinghe's plea and considering the continued dilemma of the public (see section: Something is wrong -para two) I felt it was unethical for me (as a professional in Nutrition) to remain silent any longer considering that Mr. Wic is a heart patient and there may be thousands of other individuals in the same predicament.
To be continued next week.
The writer is Dr Damayanthi Perera Ph D - Human Nutrition (London) Nutrition Consultant/ Independent Researcher.


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