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1 Research Guild, Vol. 2, No 1, 2014
RGUILD
Research Guild
http://rguild.org/2014/07/3123
Jedi-jedi: Towards A Formal Medical Classification Of
A Sugar Problem In Africans
Peregrino Brimah1; Rotimi Adigun2
1Every Nigerian Do Something [ENDS.ng]; 2Windsor University School of Medicine, Cayon, Saint Kitts
Objective: “Jedi-jedi” is a very common presenting complaint
in medical centers and social circles in West Africa. The
symptom, constellation of symptoms or syndrome is not
formally classified as a disease entity or syndrome in orthodox
medical practice. Low back pain and erectile dysfunction are
some of the more common presenting complaints that are
qualified as Jedi-jedi. Sugar is largely implicated in the
etiology of this health problem and abstaining from sugar and
herbal remedies are commonly used to remedy the symptoms.
Method: Data were obtained from survey respondents who
participated in a 2013-2014 ENDS internet survey. 298
respondent forms were used for the study. The survey was
conducted online through the Survey Monkey internet survey
platform. Respondents were gathered from Every Nigerian Do
Something, ENDS.ng visitors and through posting on several
other Nigerian internet media fora.
Results: Analysis showed that 80% of respondents reported having
experienced Jedi-jedi. Most respondents were men and 98% were
Nigerians. 56% reported low back pain as the most common presenting
symptom of Jedi-jedi. Next was anal pain, 46%; bloody stool, 36% and
erectile dysfunction, 35.5%. Constipation and anal itching recorded 26%
and 29% respectively.
Conclusion: Our findings suggest that a large number of Nigerians are
familiar with “Jedi-jedi” as a “disease” or as presenting symptom(s) of
“disease.” Erectile dysfunction and low back pain are the most common
presentations. Most respondents utilized herbal remedies for the conditions
considered to be Jedi-jedi. Table sugar is the most commonly implicated
factor in its etiology. We conclude that Jedi-jedi needs to be properly studied
towards formal medical classification and management.
Keywords: sugar, sucrose, Jedi-jedi, nigeria, africa, black,
Citation: Brimah P; Jedi-jedi: Towards A Formal Medical Classification Of A
Sugar Problem In Africans. RGUILD 2014;2(1)10001
very common complaint and agnomen for a host of
medical symptoms in West Africa, “Jedi-jedi,” remains
poorly studied, classified and virtually unrecognized and
defined in African and global general medical practice.
There are different appellations for this condition across West
Africa and other African populated Caribbean states, these
include, “Diabetes” in Ivory Coast, “Pile” in Nigeria and “the
running” in Ghana.
This rather common medical patient complaint and accepted
local ailment is currently unrecognized and virtually unutilized
in the standard health-care setting.
“Jedi-jedi,” has been associated with the following listed
symptoms and medical conditions:
- Hemorrhoids
- Puritus ani
- Diarrahea
- Anal fissure
- Anal fistula
- Rectal prolapse
- Diabetes
- Lower back pain/weakness
- Erectile dysfunction
A proper review of this medical presentation and group of
complaints requires investigation into the common attributed
causes. Commonly implicated are:
- Consumption of sugar
- Consumption of hot pepper
In common practice, medical professionals when confronted
with the Jedi-jedi complaint, determine from the patient the
particular symptom experienced, which could be one or a
combination of the earlier listed presentations/symptoms. The
patient is then investigated and offered therapy based on the
predominant presenting known symptom(s).
Not currently recognized as a medical entity, the complaint,
Jedi-jedi is never investigated and treated as a disease, symptom
of disease or possible syndrome of its own. There is a dearth of
material on Jedi-jedi as a possible unique syndrome, symptom
or disease entity.
A
P Brimah, R Adigun
2 Research Guild, Vol. 2, No 1, 2014
Complementary and Alternative Medicine (CAM)
In contrast to the orthodox approach on Jedi-jedi, CAM
practitioners in West Africa have for decades viewed Jedi-jedi
as an actual disease entity and syndrome; and provided
standardized remedies for its most common presenting
symptoms.
Local classification: At the local level, Jedi-jedi is recognized as
an important medical condition that requires its unique
therapeutic remedy, which is commonly sought from CAM,
usually without considering seeking professional/orthodox
medical care.
Jedi-jedi is diagnosed locally based on the above listed plethora
of symptoms and treated with herbal concoctions and roots
usually to address some of the most disturbing symptoms, like
the lower back pain/weakness and sexual dysfunction. Avoiding
the perceived precipitators, usually sugar and/or pepper is also
standard.
Previous studies have discussed Jedi-jedi especially in reference
to childhood diarrhea. M. K. Jinadu et al’s study based on 335
respondents, found participants describe that Igbe ghuuru
(copious diarrhea) could deteriorate into Jedi-jedi if sweet foods
are not avoided. 1
The study also found sugar to be a major factor in the locally
perceived etiology of Jedi-jedi.
Patronizers of the alternative therapeutic options are relatively
satisfied with the herbal remedies offered. Unless their “Jedi-
jedi,” gets complicated by severe or chronic diarrhea, bloody
diarrhea, hemorrhoids or Pile – inflamed hemorrhoids, do they
then visit orthodox health care centers.
Local remedies given for “Jedi-jedi” include, “Burantashi,” a
Hausa word that literally means, “raise-the-penis,” or “get it
up.” There are different versions of Burantashi, which may
come in powder form or the bark, which is chewed. It is very
commonly sold by Hausa’s from the Northern regions of West
African states to be ingested as a remedy for the erectile
dysfunction associated with “Jedi-jedi.” Burantashi contains
alkaloid Yohimbe, an alpha-2 antagonist with vasoconstriction
effects, which explains its prescription for managing erectile
dysfunction. Extracts of the bark were also found to have
endothelin receptor A and B agonist effects, and released nitric
oxide. 2
“Agbo Jedi-jedi” is a commonly used local herbal preparation
made from combinations of water extracts of leaves, bark, roots
and other chemicals. Common ingredients are, bitter leaf
(Vernonia amygdalina Delile), Sorghum (Sorghum bicolour
Moench) leaves, Scented-leaves (Pelargonium zonale (L.)
L'Hér.), grapefruit (Citrus paradisi Macfad.) juice extracts,
naphthalene tablets, garlic (Allium sativum L.) and Camphor.3
Agbo Jedi-jedi is widely used in Nigeria; a study of 200 mothers
attending a Lagos health clinic and found that 80% of them gave
the concoction to their children. 4
Another study that investigated the extent of use of herbal
medicine in Lagos, Nigeria, gathered from 388 respondents that
67% used herbal medicine and of these, Agbo jedi-jedi (35%)
was the most frequently used herbal preparation. It must be
pointed out that the usage does not translate to prevalence of
perceived Jedi-jedi, as Agbo Jedi-jedi is not only administered
for Jedi-jedi, and is also given sometimes as a preventive
therapy. 4
Other local remedies for Jedi-jedi include, “Opa-Eyin;” these
are a concert of herb-laden gin drinks sold to adults on street
corners and consumed to alleviate the lower back pain/weakness
and erectile dysfunction associated with Jedi-jedi. Opa-Eyin is a
Yoruba term that literally means, “back rod,” which signifies its
application as a remedy for the “lower back weakness,” and
erectile dysfunction or impotence associated with Jedi-jedi.
In most cases of the illness, sugar and/or spicy pepper were
avoided as part of management.
There could also be psycho-social components to this ethno-
medical complaint. Hence a combined medical, surgical and
psychological investigation into Jedi-jedi and any global
equivalents is imperative.
The importance of properly investigating this prevalent
condition cannot be overstated. For simplicity in this paper, we
refer to the various regional equivalents of this possible
disorder, with the single “Jedi-jedi,” sobriquet.
Etiopathogenesis
Sucrose (cane sugar) is most commonly implicated in the
perceived etiology of Jedi-jedi. As a possible etiological factor,
the metabolism of dietary sucrose can be studied in three
categories:
- Sucrose intolerance and osmotic diarrhea
- Effects of absorption of Sucrose breakdown products
- Increased GI Sucrose absorption and leaky gut
Sucrose, glucose and fructose are distinct carbohydrate
molecules. Sucrose sugar, with molecular formula - C12H22O11,
is a disaccharide, 2-Carbon sugar molecule which is broken
down by enteric sucrase enzyme to glucose and fructose, two
monosaccharide sugars. Sucrase acts on Sucrose sugar in the
small intestine. This hydrolyzing enzyme is secreted at the tips
of villi of the small intestinal epithelium. Fructose, C6H12O6 is
an isomer of glucose (C6H12O6).
Sucrose intolerance and osmotic diarrhea
Congenital sucrase-isomaltase deficiency (CSID) is a disorder
linked to SI and SII genetic mutations that presents with
decreased ability to breakdown Sucrose and Maltose (grain)
sugars. This results primarily in osmotic diarrhea 5, 6
The prevalence of CSID is estimated at 1 in 5,000 people of
European descent and up to 1 in 20 of Alaskan and Greenland
decent.
Jedi-jedi: Towards A Formal Medical Classification
3 Research Guild, Vol. 2, No 1, 2014
Eskimos also have a higher incidence of Sucrose intolerance,
and this is becoming a rising public health concern with their
increased sugar consumption. 7
Recent studies have proposed quantitative disaccharide assay
tests to determine the prevalence of the autosomal recessive
inherited CSID, which might prove the condition to not be as
rare as currently estimated. 8
There is no information on disparities in sucrose tolerance
between Blacks and other races/ethnicities; and more
specifically, in particular relation to West Africans and other
Caribbean Africans who present with the “Jedi-jedi” complaints.
West Africans have recently experienced drastic dietary
changes, with significant increase in sucrose consumption.
Effects of absorption of Sucrose breakdown products
Research is increasingly focusing on the unique properties of
various consumed sugars and identifying their comparative
health impact. Recent studies on fructose consumption suggest
that it is more harmful to humans than regular sugar with
findings that high levels may increase the risk of obesity,
cardiovascular disease, diabetes, and non-alcoholic fatty liver
disease. 9
Consumption of fructose sugar, High fructose corn syrup
(HFCS) in the United States, US has jumped 1000 fold in the
last two decades. The US is the leading consumer of HFCS. In
Europe and Africa, cane sugar is the leading sugar in beverages
and other food products. Europe, EU has a quota on high
fructose syrup in place for “fair agricultural/economic
development.” This EU quota was first established in 2005, and
most recently amended in 2011. The quota is not based on
health issues, but rather the protection of development across all
EU territories. 10 Sucrose on the other hand has been associated
with a higher post ingestion peak in levels of plasma glucose,
when compared to fructose. In one study, 100 gm. glucose,
fructose, and sucrose doses given to test subjects after an
overnight fast produced lower plasma glucose and insulin peaks
after fructose ingestion as compared with glucose and sucrose.
Fructose doses resulted in lower glucagon suppression. 11
Several other studies have suggested that dietary fructose
produces a lesser postprandial rise in plasma glucose than
sucrose and glucose. 12, 13, 14, 15, 16, 17
Investigation on the effects of administration of sucrose,
sorbitol, and fructose (35 g) to normal and diabetic subjects,
resulted in the highest mean peak increment in plasma glucose
after the sucrose meals (44.0 mg/dl for normal subjects; 78.0
mg/dl for diabetic subjects) with intermediate glucose levels
after fructose meals (29.0 mg/dl for normal subjects; 48.0 mg/dl
for diabetic subjects). 16
The differences in these two common sugar forms may explain
why people who complain of “Jedi-jedi,” usually relate it to the
consumption of sucrose constituted beverages and not HFCS
sweetened foods.
The more favorable immediate effects when fed HFCS might
also explain the propensity for such beverages and foods to be
consumed to a greater degree, hence predisposing to an
increased risk of obesity and other investigated sugar – related
disorders, as compared to territories where sweetening is
achieved with sucrose sugar which presents with more
immediate consumption related discomfort and distress, hence
reducing intake.
Increased GI Sucrose absorption and leaky gut
Plasma sucrose levels may also be a focus of study in the
pathogenesis of Jedi-jedi. Ingested sucrose is readily cleaved to
monosaccharide sugars by sucrase activity at the brush border
membrane/ villi tips in the region of the upper gastroduodenal
mucosa. However this depends on an intact upper GI mucosal
lining. The early breakdown of sucrose has set it up for modern
use as a marker in investigating NSAID related upper GI
gastroduodenal epithelial damage, and tests measure sucrose in
urine to detect the damage and upper GI leakage.
Leaky gut syndrome and hot pepper:
Covering over 400 sq meters, the gastrointestinal mucosa is the
largest interface between the internal and external environment.
The mucosal lining serves as the protective layer of this barrier.
Permeability of the intestinal barrier can be a very important
health determinant. “The major determinant of the rate of
intestinal permeability is the opening or closure of the tight
junctions between enterocytes in the paracellular space.” 18
Several factors contribute to the intactness of the mucosal
lining. Leaky gut syndrome, defined by an increased
permeability of the gastric mucosa, is not a popular tool for
predicting disease in conventional medicine, but studies have
shown that a leaky gut predisposes to infections, invasion with
micro-toxins and overall ill health. Integrative doctors focus
more, not on the disease but on the functional dysregulations
that may be behind it. Hence it is not surprising that Integrative
therapy considers leaky gut in the etiology of ulcerative colitis,
food intolerance, inflammatory bowel disease, rheumatoid
arthritis and other autoimmune diseases.19
Alcoholic patients have been found to have altered intestinal
permeability in the small bowel, which leads to micro-toxin
entrance and extraintestinal damage with the common gastritis
presentations. 20
Large macromolecules absorbed into the body can cause
inflammatory conditions, as the immune system recognizes
them as foreign invaders setting up an immune defense reaction
and consequent inflammation. Increased blood levels of sucrose
have been attributed to hyperinsulinism as well as an increase in
platelet adhesiveness. 21
Cayenne pepper and other strong spices open the mucosal
barrier, and have been linked to leaky gut. West Africans are
known for high hot pepper consumption. There are many effects
of the mucosal leakage which include proposed mechanisms
relating to the development of diabetes in patients with leaky
guts, these could be by the entrance of foreign substances which
irritate the intestinal immune cells or the introduction of
mucosal cell proteins setting up immune reactions which affect
P Brimah, R Adigun
4 Research Guild, Vol. 2, No 1, 2014
insulin producing cells. 22 The relationship of Cayenne pepper
with leaky gut, prompts a host of investigations on Africans who
consume high doses and have complained of Jedi-jedi related
symptoms.
Altomare DF et al, demonstrated in a study on hemorrhoids and
hot pepper in fifty patients, that 48 hours after administering a
capsule of red hot chili pepper, hemorrhoidal scores, which
included itching, burning, bleeding, swelling and pain, remained
unchanged in the study subjects. 23
Another study in 2008, investigating the effects of chili pepper
on 50 patients with anal fissures and hemorrhoids, concluded
that chili pepper did increase the symptoms of acute anal fissure
and reduces patient compliance. 24
There could be relationship between pepper induced leaky gut
and increased intestinal absorption of sucrose. It is important to
study the interplay of both culprits in Jedi-jedi, Sugar and
pepper, in the leaky gut syndrome in West Africans who present
with Jedi-jedi.
Procedures and Participants
To collect data on the perception of West Africans, most especially
Nigerians to Jedi-jedi, we registered a Survey Monkey 25 account
for simple data collection and analysis. The questionnaire had ten
short questions and was distributed through online for a including
the Every Nigerian Do Something, ENDS.ng platform 26 and other
fora that had a high Nigerian readership. Responses were gathered
between February 2013 and March 2014. A total of 298 provided
answers to the survey. Data was analyzed and charts were created
with the Survey Monkey automatic software.
Survey Questions:
The questions asked were:
1. Have you ever had Jedi jedi/Pile?
2. What was the presentation? (please select as many as apply)
3. What do you think causes it?
4. Is there a particular type of drink sugar you noticed on the
bottles that causes your Jedi jedi/Pile?
5. What do you most frequently use to treat your Pile/Jedi jedi?
6. Pick all other things you do to treat your pile/Jedi jedi
7. What name do you call Jedi jedi/pile?
8. What is your sex?
9. What is your nationality/race?
10. What's your age?
Statistical Analysis
The data was gathered from a cross-sectional survey run on the
independent Survey Monkey platform. All results were collected
and exported as SPSS file with its corresponding data set file and
responses were categorized for analysis. Statistical tests were
considered significant at P<0.05. All analyses were performed
using SPSS 18.0.
Q1. Of the 298 respondents, 80% reported having experienced
“Jedi-jedi.”
Q2. 262 takers answered this question. Multiple selections were
possible. The most common presentation was lower back pain;
with 56% of respondents selecting this response, which
corresponded to 141 persons. The next most common
presentation was anal pain with 46% response rate or 121
respondents. 35.5% (93 people) responded with erectile
dysfunction. Bloody stool was also a common presentation with
95 respondents; a 36% response rate.
METHODS
RESULTS
Jedi-jedi: Towards A Formal Medical Classification
5 Research Guild, Vol. 2, No 1, 2014
Q3. Most respondents blamed sugar in the etiology of the health
problem. 199 or 79% selected Sugar as the cause. 45% blamed
starchy food while 16 and 17% blamed pepper and oil
respectively.
Q4. Most respondents had not paid attention or had no idea the
exact type of sugar on the label of the foods and beverages they
attributed to the triggering of Jedi-jedi episodes. 194 had “no
idea.” Of those who knew, 57 chose sucrose and 14 chose
fructose sugar.
Q5. Most respondents, 149, or 57% used herbs concoctions,
“Agbo” to treat their symptoms. Less than 10% visited an
orthodox physician.
Q6. 55% reported using Agbo/herbs to remedy their symptoms.
50% of respondents reported “abstaining from sugar” as their
method of treating their condition.
Q7. The question was: what name do you call Jedi-jedi/Pile?
209 respondents typed in the name they use to refer to this
health problem. Most called it “Jedi-jedi.” The other responses
were: Stooling, Idakole, Inu rirun/Jedi, Basir(4 respondents),
Ajase Poki Poki, Dan Kanoma, Basir/Rana, Diabetes,
Somokunrin dode loju obo, Anal pushout, Apa afo, ntara kwu
kwu, Atini, Tumo obi, Efor Onunu, Tapa.
P Brimah, R Adigun
6 Research Guild, Vol. 2, No 1, 2014
Q8. 266 survey takers responded as being males and only 16 as
females.
Q9. 98% or 275 selected Nigeria, 6 selected “other Africa.”
Q10. Most (198) respondents were in the 20-39 age bracket. 49
were age 40-49.
There is a dearth of scientific information or evidence of
prior scientific study and elaborate research into the
constellation of symptoms that make up the “Jedi-jedi” rather
common health care presentation in West Africa. Is Jedi-jedi a
unique medical disorder, a symptom or a syndrome? Is Jedi-jedi
related to sugar – sucrose in particular – intake? Is the condition
unique to Blacks? These are some of the questions this paper
tried to highlight.
Our study attempted to prove the prevalence of this unique
medical presentation and social health complaint. We were able
to determine that there is a very high report of this condition,
with most respondents acknowledging being affected by it (Jedi-
jedi). Our survey results also presented that most Nigerians (the
most numerous respondents) who were affected by this
condition did not seek orthodox medical help for the condition,
but relied on local herbal remedies and sugar abstinence.
Survey results suggested a link between sugar (sucrose) intake,
low back pain, and erectile dysfunction which were part of the
constellation of most common symptoms presented as Jedi-jedi.
Table sugar as a predisposing factor for these presenting
symptoms needs to be thoroughly investigated.
Sucrose sugar is the more commonly used factory sweetener in
African and Caribbean nations whereas; America has converted
to the use of HFCS sweetening. Most respondents were not sure
what type of sweeteners their beverages had, but of those who
knew, most noted sucrose sugar. We find sucrose sugar to be
most implicated in the Jedi-jedi group of symptoms/disorder.
Sugar-loading and the rate of sucrose absorption in Blacks most
especially, as well as the direct effects of sugar and possible
effects of osmotic diarrhea on the prostate; and possible links
between levels of sucrose breakdown products and erectile
dysfunction should be thoroughly investigated.
Is Jedi-jedi a syndrome or metabolic disorder? Based on our
findings, we believe Jedi-jedi and its myriad of presentations
and attributed presentation symptoms needs to be fully
investigated towards categorizing it as a formal medical
syndrome. The severity and distribution of the plethora of
patient symptoms presents an important challenge to the modern
medical profession which has thus far been completely
neglected.
We were limited in scope of our research. Jedi-jedi must be
investigated thoroughly with a multi-specialty approach:
medical, psychological and surgical research into this presenting
complaint(s) will properly classify or declassify this popular
health complaint. Investigations into orthodox medical
management of Jedi-jedi as an entity will be invaluable once the
“disorder” is properly investigated and classified.
The study did not query the overall patronage of orthodox health
centers for all other ailments, which will be necessary to
evaluate the full significance of the finding of a 90% reliance on
herbal remedies and non patronage of orthodox health care
centers for “Jedi-jedi” in particular as reported.
Future studies should investigate the direct relationship of sugar
intake with presenting symptoms and evaluate possible ethnic
and racial determinates of the “disease/syndrome.”
DISCUSSION
Jedi-jedi: Towards A Formal Medical Classification
7 Research Guild, Vol. 2, No 1, 2014
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Submitted for publication March, 2014
Final review July, 2014
Published July, 2014
REFERENCES
ACKNOWLEDGMENTS
SUBMISSION AND CORRESPONDENCE
P Brimah, R Adigun
8 Research Guild, Vol. 2, No 1, 2014
Address all correspondence to: Peregrino Brimah
http://ENDS.ng Nigeria
Email: drbrimah@ends.ng
