Reducing the ill effects of air pollution …increasing cocoa consumption

Wear face masks to avoid in­haling dust particles in the air”. This was a warning from the Environmental Protection Agency (EPA) and reported by the GNA on February 20, 2023.

The most vulnerable in society (children, elderly, pregnant women) and persons with underlying con­ditions such as asthma are being asked to reduce outdoor activities and remain indoors to avoid fre­quent attacks. The EPA added that high particulate levels, higher than the World Health Organisation’s and national limit could cause irri­tation of the eyes, nose and throat. The EPA’s Quality Index Station at the University of Ghana recorded dust particles ranging from moder­ate, unhealthy and very unhealthy air from 16 February 2023. The Ghana Health Service (GHS) add­ed that individuals who exposed themselves to particles emitted into the atmosphere risked contracting respiratory-related diseases.

The website of the World Health Organisation (WHO) has lots of information on the menace of air pollution. Air pollution is contam­ination of the indoor or outdoor environment by any chemical, physical or biological agent that modifies the natural characteristics of the atmosphere.

Household combustion devices, motor vehicles, industrial facili­ties and forest fires are common sources of air pollution. Pollutants of major public health concern include particulate matter, carbon monoxide, ozone, nitrogen dioxide and sulfur dioxide. Outdoor and indoor air pollution cause respi­ratory and other diseases and are important sources of morbidity and mortality.

WHO data show that almost all of the global population (99%) breathe air that exceeds WHO guideline limits and contains high levels of pollutants, with low- and middle-income countries suffering from the highest exposures. Air pollution is a major and pressing public health threat. A record number of over 6000 cities in 117 countries are now monitor­ing air quality. WHO estimates that around 7 million people die every year from exposure to fine particles in polluted air that lead to diseases such as stroke, heart disease, lung cancer, chronic obstructive pulmonary diseases and respiratory infections, including pneumonia. Pollutants include particulate matter, carbon monoxide, ozone, nitrogen dioxide and sulphur dioxide. Both ambient (outdoor) and household (indoor) air pollution are harmful for health.

Air quality is closely linked to the earth’s climate and ecosystems globally. Many of the drivers of air pollution (i.e. combustion of fossil fuels) are also sources of greenhouse gas emissions. Policies to reduce air pollution, therefore, offer a win-win strategy for both climate and health, lowering the burden of disease attributable to air pollution, as well as contributing to the near- and long-term mitigation of climate change. Rising at an alarming rate, air pollu­tion impacts economies and people’s quality of life. It disproportionately affects women, newborn and young children. Policies and investments supporting cleaner transport, ener­gy-efficient housing, power genera­tion, industry and better municipal waste management can effectively reduce key sources of ambient air pollution.

While all the measures mentioned above are important, I find the use of flavanol-rich cocoa as very inter­esting. I will be using materials from two papers-1. Calderon-Garciduerias et al. Chocolate, Air Pollution and Children’s Neuroprotection: What Cognition Tools should be at Hand to Evaluate Inter­ventions? Front Pharmacol. 2016; 7: 232. 2.Calderon-Garci­duerias et al.Flavonol-rich dark cocoa significantly decreases plasma endothelin-1 and improves cognition in urban children. Front Pharmacol. 2013; 4: 104.

Increasing evidence links two key effects of air pollution (oxidative stress and neuroin­flammation), to developmental neurotoxicity and neurode­generative disease, particularly Alzheimer’s disease (AD). Chil­dren are exposed to significant amounts of complex mixtures of air pollutants, and their de­veloping brains are at high risk for deleterious effects. Millions of children across the world are exposed to multiple sources of indoor and outdoor air pollutants, including high concentrations of fine particulate matter (PM2.5) and ozone (O3). There is an established link between exposure to PM2.5, brain structural, volumetric and metabolic changes, severe cognitive deficits, and the presence of Alzheimer’s disease (AD) hallmarks in urban children and young adults and the deleterious neural effects of pollution exposure. Systemic inflammation and increased concentrations of potent vasocon­strictors (i.e., endothelin-1, ET- 1) are critical features of children’s exposure to the pollution. The in­flammatory response to air pollution correlates with cumulative exposures to PM2.5 (as well as total outdoor exposure hours), and occurs in con­junction with sustained inflammation of the upper and lower respiratory tracts and endothelial dysfunction. A key consequence of air pollution exposure is neuroinflammation.

40% of highly exposed children and young adults in Mexico City exhibit frontal tau hyperphosphor­ylation with pre-tangle material and 51% have amyloid-β diffuse plaques as compared to 0% in low pollution controls. Clinically healthy Mexico City Metropolitan area (MCMA) children exhibit MRI prefrontal white matter hyperintensities (WMH) and significant selective impairment in attention, short term memory and learning ability in the absence of known risk factors for cognitive and neurological deficits.

Systemic inflammation and increased concentrations of potent vasoconstrictors (i.e., endothelin-1, ET-1) are key features of exposure in MCMA children, as they correlate with cumulative exposures to fine particulate matter (PM) and outdoor exposure hours, and are a reflection of the sustained inflammation of the upper and lower respiratory tracts and endothelial dysfunction. Air quality in MCMA stands among the worst in the world. Children are exposed all year long to a significant burden of air pollutants, including concentrations above the current US standards for ozone, and fine PM <2.5 μm in diameter (PM2.5). Neuroinflammation and endothelial dysfunction are critical for a proper brain growth and development. Neuroprotection is critical for pediatric and young adult populations residing in highly polluted environments.

MCMA is the largest urban cen­ter in North America and a good example of extreme urban growth and environmental pollution. The metropolitan area of over 2000 square kilometers is home to 20 million inhabitants including 8 mil­lion children. The energy demand of this population, over 40,000 industries and 4 million vehicles consume more than 40 million liters of petroleum fuels per day producing an annual emission of ~2.6 tons of pollutants including coarse and fine PM, gaseous pol­lutants, polycyclic aromatic hydro­carbons, and lipopolysaccharides.

The study assessed whether a short cocoa intervention can be effective in decreasing plas­ma endothelin 1 (ET-1) and/or inflammatory mediators in MCMA children. Thirty gram of dark co­coa with 680 mg of total flavonols were given daily for range 9–24 day to the children. Key metabolite ratios in frontal white matter and in hippocampus pre and during cocoa intervention were quantified by magnetic resonance spectrosco­py. l ET-1 significantly decreased after cocoa treatment. There was improvement in one or both of the applied simple short memory tasks. Endothelial dysfunction is a key feature of exposure to partic­ulate matter (PM) and decreased endothelin-1 bioavailability is a usefulmarker for brain function in the context of air pollution. Flava­nol-rich cocoa intake is critical for early implementation of neuropro­tection of highly exposed urban children. Multi-domain nutraceu­tical interventions could limit the risk for endothelial dysfunction, ce­rebral hypoperfusion, neuroinflam­mation, cognitive deficits, struc­tural volumetric detrimental brain effects, and the early development of the neuropathological hallmarks of Alzheimer’s and Parkinson’s diseases. Regular and daily intake of flavanol-rich cocoa reduces the ill effects of air pollution.

Do you know Cocoa Clinic is the first to introduce endoscopic procedure as a diagnostic tool in Ghana? 2023 is our 50th Anniver­sary.

[The writer is the Chief Pharmacist Cocoa Clinic]

By Dr. Edward O. Amporful

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