Dr harold Gunatillake

Keeping your Circulatory system, healthy

There are two circulatory systems: blood circulatory system and lymphatic system in our body, and efficient working of those systems keep us healthy and shapely, too. 

We are only discussing about the blood circulatory system, also called cardio-vascular system, in this article. The central pump (heart) including the receiving pump in thissystem are the central figures most important to deliver nutrients and oxygen to the cells of the body and return the de-oxygenated blood (bad blood) back to the right chambers of the heart be sent to the left chambers of the heart after purification( oxygenation) in the lungs.Just like the circulatory system the pump (heart) needs to be maintained in prime condition to remain healthy.

 The complex system of circulation that supplies nutrients and oxygen can get disturbed and result in diseases detrimental to our health.

 The pipes (arteries) in this system can get damaged. In healthy situations, they are flexible, elastic and expandable, as seen mostly in young kids. In a condition called Atherosclerosis these pipes can get hardened in patches with fatty deposits from your food and other inflammatory processes, may cause partial obstruction to the flow of oxygenated blood and micronutrients, resulting in irreparable harm to your body.

Such pathological changes do occur with age, and lifestyle changes. High blood pressure is one of the commonest outcomes of thickened arteries. High blood pressure may affect your heart, kidneys, eyes, cognitive decline and may lead to stroke through neglect.

There is a difference between ‘Arteriosclerosis’ and ‘Atherosclerosis’. One could say that the latter is a specific type of arteriosclerosis. The former occurs through aging and is a natural phenomenon in all human beings. Over time the walls in your arteries can harden for no definite reasons, other than just aging and genetics may play a part in it.

When you are over forty, you need to check your blood pressure yearly, failing will result being a victim to this silent killer.

According to the American Heart Association under the new guidelines the BP should be below 130/80 from 140/90 millimeters of mercury. Above these figures you enter the criteria for stage 1 hypertension.

Lifestyle changes without pills can lower blood pressure, during this early stage of hypertension. Lose weight, read labels, avoid foods containing very high amounts of sodium (salt) such as breads and rolls, cold cuts and cured meats, pizzas, and Chinese food. Did you know that Chinese and Japanese food includes lot of salt? It is paradoxical why those nations do not show a higher incidence of hypertension and other circulatory problems.

Heart disease: Not only blood vessels supplying the periphery of the body gets affected in hypertension, the coronary blood vessels of your heart can get constricted with hypertension. These vessels get blocked by blood clots and lead to anginal episodes and heart attacks. So, always keep your BP in the normal approved range.

With chronic neglected hypertension your heart valves can prolapse and lead to incomplete closure, leading to leak and back flow of blood (regurgitation). Narrowing of the valves in hypertension can cause stenosis (narrowing) and preventing the free flow of blood from the heart.

Arrhythmias: With uncontrolled blood pressure, the heart muscles get strained and stressed and contractions could become erratic, can cause abnormal heart rates and rhythms. You could always self-diagnose this condition from feeling an irregular pulse rate at your wrist, or a dropped beat.

High cholesterol: You may have read that cholesterol has made a U turn, giving you the idea not to worry about eating foods with high cholesterol. It is partially true that cholesterol in your food such as in eggs may not influence the cholesterol numbers in your blood, but remember most foods have high saturated fats along with natural cholesterol that harms. So, avoid unhealthy diets, and lead an active life with regular exercise to lower your cholesterol in your blood. The bad cholesterol (LDL) do collects in plaques and damage the blood vessels (arteries). If you have high cholesterol due to genetic factors, you need to take statins to control the cholesterol numbers in your blood.

Heart failure: With high blood pressure the peripheral blood vessels tend to get stiff and non-elastic. This leads to back pressure on your pump (heart) and cause additional strain on your left ventricle that pumps your blood to the rest of your body.

Neglecting your hypertension ultimately leads to heart failure. Initially the heart muscles get hypertrophied (expanded). At this stage x rays reveal an enlarged heart. If no remedial action is taken the muscles can get weak and go into failure. At this terminal stage, there is water-logging in your body, lead to fatigue, shortness of breath, coughing, and lead to a miserable life causing much misery to yourself and loved ones.

Stroke: Due to high blood pressure the vessels supplying the brain can rupture, or lead to blockage with blood clots and prevent oxygen from getting to the brain.

Most strokes are preventable. You only need to keep your BP under control with healthy lifestyle changes.

Peripheral artery disease (PAD): With chronic hypertension your peripheral blood vessels could narrow just like the central ones. Uncontrolled diabetes is one of the main culprits that can cause this condition, and ultimately leads to gangrene of limbs needing amputation. Such incidents are rare today, as most people have access to good health care.

Carotid artery stenosis: In addition to narrowing of the limb vessels, it is quite common to see the carotid arteries supplying blood to the brain getting restricted with plaque formation in these main vessels in the neck. The plaques can get dislodged, ulcerate and bleed, causing a condition called Transient ischemic attacks (TIA). This leads to a transient stroke, a warning sign for action to prevent a full- blown stroke.

Aortic aneurysms: Uncontrolled hypertension can lead to ‘ballooning out” at weak points I your blood vessels, as at bifurcations of vessels. These bulges or aneurysms could burst and become medical emergencies.

Other factors: To keep your circulatory system healthy you need to be aware of the consequences of neglect. Smoking can damage your blood vessels. Fortunately, the incidence of smoking among the adults are reducing, whilst it catches on among the young and in third world countries where the cigarette companies still promote through advertising.

Being overweight could be a strain on your heart and circulatory system. However, awareness, keeping your weight under controlled with healthy low-calorie diets and exercise the risk could be reduced.

Inflammation from diseases: There are certain diseases where thickening and narrowing of blood vessels are inevitable, includes arthritis, lupus an autoimmune disease, and inflammation due to unknown causes.

Conclusions: Be aware of circulatory diseases and take lifestyle measures to prevent them. Do not weight to see the doctor until you get a life-threatening circulatory problem, as they are all preventable unless there is a congenital or familial factor.

Eating a healthful diet, checking your BP regularly, exercising, not smoking can avoid these preventable issues in your circulatory system. If you are a diabetic, you need to tightly control blood sugar levels with proper diet and medication.

Hope this article will help you to stay fit and lively.

Dr Gunatillake-Health editor is a member of the Academy of Medicine, Singapore. Member of the Australian Association of Cosmetic Surgery. Fellow of the Royal College of Surgeons (UK), Corresponding Fellow of the American Academy of Cosmetic Surgery, Member of the International Societies of Cosmetic surgery, Fellow of the International College of Surgery (US), Australian diplomat for the International Society of Plastic, Aesthetic & Reconstructive Surgery, Board member of the International Society of Aesthetic Surgery, Member of the American Academy of Aesthetic & restorative Surgery, Life Member of the College of Surgeons, Sri Lanka, Batchelor of Medicine & Surgery (Cey). Government scholar to the UK for higher studies.


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“Good advice by Dr. Harold –

Just one drink a day will keep you

away from Dementia- latest finding”


desmond kellyThis would be the best news that most middle-aged people would want tohear, yes, it is true the latest studies reveal. Just drinking one glass of wine a day, lowers the risk of your developing dementia later in life, the researchers have come to that conclusion.

This study was done on 9,000 British adults for a period of twenty years. This study also revealed that the teetotallers and heavy drinkers have a high incidence of dementia.

Just one drink means 14 “units” of alcohol per week, that is a medium-sized glass ofwine or one pint of beer, each day.

No wonder, those adults working hard during office hours and patronizing the pub,drinking just a pint of beer and going home and greeting their love one, would keeptheir brain stimulated, then the guy who goes home tired after work going straight tobed after a quick dinner.

Studies showed that people who were non-drinkers in middle age were 47 percentmore likely to eventually be diagnosed as having dementia, against those ‘one drinkers’, the findings revealed.

The above studies also revealed that middle-aged people who drank more than a glassper day their risk of dementia increased in proportion with their alcohol intake. It wasalso shown that more than one glass drinkers the dementia risk rose by 17 percent with every additional 7 units of alcohol (3-4 glasses of wine per day) they drank per week.

DR. Sevil Yasar, an associate professor of medicine at John Hopkins University,Baltimore, had no answer when asked why non-drinkers should have a high risk ofdementia compared to those who drink a glass a day.

It is possible that the lifestyles of those who drink, and non-drinkers differ, and thebrain cells gets the opportunity to unwind and relax which may be a good reason fordaily activation of those cells to prevent dementia later in life.

Researchers also have found that moderate drinkers are less likely to get heart attacksthan are abstainers. Therefore, the alcohol in wine might be a factor in the Frenchparadox. It appears that the same factors that raise the risk of heart disease may alsoincrease the risk of dementia

It is possible, that unwinding at the end of the day with one alcoholic drink may relaxthe brain cells, cardiovascular system and other organs to have that beneficial effect onthe body to prevent dementia and heart attacks.

It is likely that the brain cells are harmed and accelerate the damage rates of the braincells among heavy drinkers and that may be a cause for dementia later in life. Braincells do not die as we age, a new finding. There seems to be widespread conservationof brain cells as we age, and the neurones don’t seem to die, but you lose neurons asyou age.

Studies have shown that healthy men and women continue to produce new neuronsthroughout life, suggesting older people remain more cognitively and emotionally intact than previously believed. Just a drink of alcohol may be an adjuvant for this process. 

It is also a myth that moderate drinking alcohol kills brain cells. Excessive drinking does damage brain cells but does not kill brain cells.

Though studies reveal that one drink a day keeps you out of dementia later in life, thatdoes not mean that you should neglect other beneficial factors that keeps you healthy:
good nutritious food, exercise, less stress, happy family relations are all important tokeep your brain cells active and alive to prevent dementia.

The incidence of dementia among Sri Lankans was very low decades back. Most middleaged people could afford to drink a glass of toddy daily, and the high doses of vitamin B1 and moderate amount of alcohol in a glass may have been responsible for such low incidence of dementia.

Today, there are hardly any toddy tappers and most middle-aged people cannot afforda glass of toddy, daily.

A study was done in the suburban region of Ragama among the Sinhalese speakingpeople by H.A.de Silva, S.B.Gunatilake and A.D.Smith, published 25 July 2003, and their conclusions were that compared with other community studies performed in North India suggests that dementia prevalence is higher in Sri Lanka, as much as 3.98%. 

The incidence of dementia among the social groups in the more affluent regions in SriLanka are much less, compared to the rural suburbs. Lifestyle changes may beattributed to the lower incidence of dementia.

If your doctor does not allow you to drink moderately daily, change the doctor to onewho enjoys a glass of wine, at the end of the day.

(Ref: Article written by Amy Norton-HealthDay Reporter, on healthy Aging)

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Eggs Do not Cause

Heart Disease or Stroke – 

By Dr. Harold Gunatillake


It was taken for granted right along, because an egg nicknamed a ‘ball of cholesterol’ posed a danger for heart disease. Housewives did not give their husbands eggs for breakfast for the same reason. Ten years ago, we did say that the cholesterol in foods, including the cholesterol in the yolk of eggs, did not influence or affect the bad cholesterol level in your blood. Some studies in the past revealed that those who had cardiovascular episodes should never touch eggs. So, everybody joined the band wagon, including popular websites and health magazines saying that eggs are bad for you.

If an egg has the nutrients to give birth to life, those nutrients should benefit mankind too.

One study published in 2013 in BMJ, revealed that eating an egg a day was not tied to any risk of heart disease or stroke.

Another recent research study published in the American Journal of clinical Nutrition, suggested that a “high egg diet” of up to 12 eggs per week did not increase heart disease risk.

Lead investigators Prof. Liming Li and Dr. Canquing Yu have now found that an egg diet consumed regularly will protect cardiovascular health.

According to a study published online May 21 by the journal Heart , revealed that people who ate an egg every day had an 18% lower risk of dying from cardiovascular disease and a 28% lower risk of experiencing a deadly haemorrhagic stroke, compared with people who didn’t eat eggs.

The researchers found that those who ate one egg per day had a 26 percent lower risk of hemorrhagic stroke, a 28 percent lower risk of death due to this type of event, and an 18 percent lower risk of cardiovascular related mortality.

All new studies show that there is an association between moderate level of egg consumption (at least one per day) and a lower incidence of heart disease.

Eggs are a great source of healthy nutrients, including high quality proteins, vitamins, including A, D, B12, B6, and minerals like calcium, magnesium, iron, sodium potassium, lecithin and phospholipids. Eggs have no vitamin C. If vitamin C was included in eggs the taste would be different.

The proteins in eggs are high quality, and more than half of it are in the white of eggs, along with vitamin B2. The white of eggs have very little fat and cholesterol, and mostly found in the yolk. The white of the eggs are rich source of selenium, vitamin D, B6, B12 and minerals like zinc, iron and copper.

Eggs contain all the essential nine amino acids the ones that are not synthesized in your body.

Select the brand of egg containing omega-3 fatty acids, depending on what the chickens have been fed. These eggs are available in the supermarkets in Sri Lanka. Read the label before you buy.

Give your growing kids at least two eggs a day for better performance in school, and excel in sports.

Conclusions: Please eat at least an egg every day, because such nutritious balls lower the risk of heart disease and stroke.

(Some reference to article written by Maria Cohut on the same topic)

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Media Release

It’s not too late to vaccinate before flu season kicks Off

Take-up of the free flu vaccine for under-fives has risen following the recent death of a toddler but NSW Health is urging all people eléible for a free flu shot to vaccinate before the flu season kicks off.

NSW Health’s latest Influenza Surveillance Weekly Report shovved 232 confirmed flu cases for the week ending 15 July, much lover than the 2,127 notifications in the week in 2017.

Dr Vicky Sheppeard, Director Comnwnicable Diseases NSW Health, said the nunber Of flu cases across the state rernained low, indiating the flu season has not yet arrived.

“Following reports last week about the death of a srrull child from influenza. there has been a notable increase in parents taking advantage of the free influenza vaccine for children up to five years of age,” Dr Sheppeard said.

“There are plentiful supplies of this vaccine and urge parents to visit their GP sooner rather than later as it takes tvvo væeks for the vaccine to take effect, and children having the shot for the first time require two doses, one rmnth apart.”

The NSW is spending a record $22.75 million on state-wide immunisation programs which will assist with flu prevention this season. This includes $3.5 million for free flu shots to children up to five years of age and a $175 million imnwnisation and influenza  prevention campaign

Flu shots are also free under, the National Immunisation Program, for pregnant wornen, people over 65 years of age. Aboriginal people and those ‘Mth medical conditions such as asthnu, diabetes and heart problems.

Dr Sheppeard said it likely the high uptake of the flu vaccine across the community vas one of the many factors behind the slow start to the flu season this year.

“It’s not too late to vaccinate and v’,e’re encouraging everyone, particularly pregnant Wonm and the parents of young children, to arrange the flu shot before the season starts,” she said.

“Vaccination is the best protection against flu but you can help prevent it spreading by coughing and sneezing into your elbow, cleaning your hands and staying honp when sick.”

NSW Health is closely rnonitoring flu case numbers and issuing an Influenza Surveillance Weekly Report every Friday to keep the community up to date on influenza activity.

The Influenza Surveillance Weekly Reports can be viewed on the NSW Health Web Site.

Media contact: NSW Health Public Affairs unit — 02 9391 9121;

After-hours — 02 9962 9890;



Tel. 02 9391 9121  A/Hours. 02 9962 9890  Fax. 02 9391 9575 Web. www.health.nsw.gov.au

 healthdirect AUSTRALIA – providing expert health advice 24 hours a day to NSW residents – Tel. 1800 022 222

Brochure: Are you at risk of severe flu?

Brochure: Vaccinate against flu. Protect your baby too

Poster: Vaccinate against flu protect your baby too




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Selecting diets when you are a diabetic –
By Dr. Harold Gunatillake 

Non- diabetics can eat a multitude variety of foods without selection,but when you are a diabetic there are known restrictions you need to follow to keep your blood sugar within the normal range. In brief, the aim of diabetic treatment is to bring blood sugar (glucose) as close to normal ranges as possible through dietetic and other regimes.

During fasting, when you have not eaten any food overnight, should read 70-99 mg/dl  (3.9-5.5 mmol/K) This would be the ranges for non-diabetics. Diabetics should not attempt to reach such low levels, as the chances of going into ‘hypoglycaemia’ may be high. On an average a diabetic should keep the fasting sugar at about 110mg/dl or between 80-130mg/dl (4.4-7.2 mmol/L). If your fasting level is above 126mg/dl falls into the category a‘prediabetic’.

When you plan a diabetic diet, you need to consider the calorie content of each ingredient to get a handle on your weight and feel better, as well. So, in short you need to watch your portion sizes and calories.

There are certain foods high in fat and added sugar you need to avoid, such as sweets,ice cream, puddings, sugar drinks and most fatty food. Also, it is advisable to restrict your salt intake in your cooked foods.

Let’s discuss the staple diet of the Sri Lankans living in Sri Lanka and expats living in other countries.Eating white rice seems to be popular for lunch and dinner, because of its colour, flavour, easy cooking, and easily converted to more palatable dishes like fried rice and so on. Though it is a versatile grain, cheap and easy to cook, contains too much of starchy calories not well recommended for diabetics. In fact, one cup of cooked white rice contains around 240 starchy calories that gets converted into fat in the body, if they are not burnt off.

Sales in supermarkets of polished white rice is much greater than more health and  nutritious red or brown rice, in Sri Lanka.

White rice being minus the outer bran and being polished gets absorbed much quicker than the unprocessed brown or red rice. This causes a problem among diabetics. Being absorbed fast through the gut as glucose, may rapidly increase glucose levels in the blood and even cause spikes. You tend to get hungry sooner than consuming the unprocessed varieties of rice. Further, micro- nutrient content is much less.

Diabetics should avoid white processed rice and always consume unprocessed rice for more glucose control, slower absorption and less spiking.

Resistant rice: You still could enjoy white rice being a diabetic by making the rice grain more resistant to digestion and absorption. This process is naturally created when you enjoy your plate of biriyani lumprai, fried, or pilau styled rice.

It does not mean that you should eat rice cooked in above methods daily, due to the high fat and calorie content. You could make your plain rice more resistant for your daily eating.

Researchers in Sri Lanka discovered a new simple way of cooking the white grain to  dramatically cutting down its calories by as much as 50 per cent and offer some health

All you need to do is to add a table spoon of coconut oil into the boiling water before adding your raw rice. Sudhair James, an undergraduate chemistry student from the College of Chemical Sciences in Sri Lanka, who led the research with his supervisor explained this new method of cooking rice. He presented the work at the National Meeting and Exposition of the American Chemical Society on Monday.

The rice after cooked by this method is left to cool overnight in the refrigerator, and next day you microwave to warm the rice and enjoy the fluffy white rice.

The advantage of consuming resistant rice is that our bodies cannot brake down into glucose to be absorbed and increase blood sugar levels. They pass through the large bowel where they act as more like a dietary fibre and provide benefits to the gut microbiota.

This method of producing resistant starch also applies to pasta, too.
You could also try low carb diets which limits your carb content, like Atkins or South  Beach diets. In these diets the carb content is reduced to about 40 grams, which means you could still enjoy two table spoons of starchy rice per meal. The rest of the calories are obtained from veggies, fish and meat. These diets are specifically designed to lose weight and not for diabetics. Research on the benefits of low-carb diets for type 2 diabetes is still mixed.

One of the best diets recommended for diabetics is the Mediterranean diet. It is a heart healthy diet using lots of fruits and veggies, fish chicken, nuts and olive oil,legumes and whole grain.

There is a popular diet for diabetics called the “Zone Diet”. In this diet you keep your blood sugar very low stable levels. (40% carbs, 30% protein, and 30% fat). The food you eat in these diets are selected according to the glycaemic index.

People living in Sri Lanka cannot afford to eat specially labelled diets, and for them rice and curry is the cheapest and most energy producing diet, especially to the out-door working class of people.

Today, diabetes is not uncommon among the poorer class of wage earners, though it was known as a ‘rich-man’s disease’

The low wage earners find it difficult to test their glucose levels frequently, as they cannot spend about rupees 5000 to purchase a glucometer and each testing  stripcosts   approximately  Rs. 80.00.

Visiting diabetic clinics run by the state cannot cope up with the number of diabetics arriving at the respective clinics and may have to spend hours, affecting their job situations.

Due to their inability to control their blood sugars, the public hospitals are full of them with complications, even needing amputations of limbs.

The richer folk gets diabetes due to over-indulgence, eating too much of rich high crab food, stress factors, and obesity.

They need to do 10,000 steps walk daily, reduce their carb content and alcohol use.

Low sugar veggies and fruits: Low sugar vegies include Brussels sprouts and other  cruciferous vegies like broccoli, cauliflower. Other low sugar vegies are: cucumber, kale,carrots, green beans, spinach, rocket, arugula lettuce, tomatoes and radishes.For a diabetic, fresh or frozen vegie are preferable to canned vegies because of added salt. Choose low salt canned vegies instead.

Another factor you need to investigate is those complex carbs containing high fiber. Such vegies take a long time to digest, absorption is slower and blood sugar does not spike. The University of Texas Southwestern Medical Centre found in a study that people who boosted fiber consumption from 24 to 50 grams per day showed drops in their blood sugar levels. The researchers found that, for some, changing to a high-fiber diet worked as well as some medications for diabetes

Whole plant foods are great sources of complex carbohydrates: such as Green
vegetables: whole grains and foods made from them, such as oatmeal, pasta, and whole-grain breads: starchy vegetables such as, sweet potatoes, corn, and pumpkin: Beans, lentils, and peas.

Foods that are high in carbs are: pastries, breads, rice and potatoes

Fruits which are low in sugar include all varieties of berries, mushrooms. Carambola fruit also provides amazing health benefits. It is very low in calories, only 31 in 100g, and is high in antioxidants, vitamins C and B, riboflavin, folate, niacin and minerals such as calcium, manganese, iron, zinc, and potassium. Studies have found it also control diabetes and lowers cholesterol.

Fruits that contain large amounts of sugar should be avoided. A medium sized ripe banana contains 14.4 grams of sugar almost double the amount in a ½ cup of blue berries. Now you know why blue berries don’t taste much in when added to your oatsmeal breakfast. Apples though having high sugar- 18.9 grams in a medium apple are high in quercetin, a nutrient that reduces the risk of diabetes and heart disease and stabilizes blood sugar levels. Raspberries have 2.7 grams of sugar per ½ cup serving. Strawberries have about 3.5 grams of sugar per half a cup. In brief, all berries have low blood sugar and you should eat much of them, also having antioxidant, flavones and other nutrients.

Fruits that have high fructose are pineapples (16 grams), Oranges (17 grams), Grapes over 20 grams, and mangoes.

Most diabetics feel that fruits are nutritious and good for diabetes and they eat with no
concerns about their fructose levels, affecting their blood sugar numbers. All fruits have sugar in the form of fructose and sucrose. Too much of fructose can harm you and even linked to increase belly fat, slows metabolism and gains weight and worst can cause a non-alcohol fatty liver.

1. Eat a well-balanced low carb diet, emphasizing fruits, vegetables, whole grains and lean protein, while watching total calories and getting exercise regularly.

2. Eat more vegetable products and fewer animal products.

3. Eat more fresh and homemade foods and fewer processed foods. Avoid fast food and junk food. You know what they are.

4. Choose your fats wisely. Cut down on meat, the skin of poultry, whole-fat dairy products, stick margarine, fried foods, processed snack foods, and commercial baked goods made with trans fats. Think about dressings, sauces, and cooking oil. Use olive or canola oil to cook whenever possible and moisten your bread with olive oil or soft margarine. Get “good fats” from fish and nuts.

5. Choose your carbs wisely. Cut down on simple sugars; remember that sodas, sports energy drinks, and fruit juices are loaded with sugar. Cut down on highly refined products made with white flour. Favor whole-grain, coarsely ground, unrefined products. Don’t be fooled by dark-colored bread or by labels that boast of unbleached flour, wheat grain, or multigrain flour. Instead, look for whole grain as the first ingredient, and read the fine print to learn the fiber content of a portion; more is better.Learn to like bran cereal, vegetables, fruits, nuts, and seeds. Consider fiber supplements if you can’t get enough from foods.

6. Eat more potassium-rich foods, such as citrus fruits, bananas, and other fruits and
vegetables. Eat more calcium-rich foods such as low-fat dairy products, broccoli,spinach, and tofu (but don’t take calcium supplements to boost your daily intake above 1,200 mg).

7. Eat more grain products, especially whole-grain products, aiming for at least 6 ounces a day. Count 1 cup of dry cereal; ½ cup of cooked cereal, rice, or pasta; or one  slice of bread as 1 ounce. Whole grains and brown rice should provide at least half your grains; the more, the better.Hope this article will help you to control your diabetes and for a healthier fruitful life.

Dr Gunatillake-Health editor is a member of the Academy of Medicine, Singapore. Member of the Australian Association of Cosmetic Surgery.Fellow of the Royal College of Surgeons (UK), Corresponding Fellow of the American Academy of Cosmetic Surgery, Member of the International Societies of Cosmetic surgery, Fellow of the International College of Surgery (US), Australian diplomat for the International Society of Plastic, Aesthetic & Reconstructive Surgery, Board member of the International Society of Aesthetic Surgery, Member of the
American Academy of Aesthetic & Restorative Surgery, Life Member of the College of Surgeons, Sri Lanka, Batchelor of Medicine & Surgery (Cey). Government scholar to UK for higher studies and training.

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How can you look after your Liver?

Most of our people would worry about heart attacks, cholesterol levels, and not think of keeping the liver healthy by consuming healthy diets and restricting alcoholic beverages, including sweet drinks, to respect it deserves.

All foods you eat: Carbs, fats, proteins are broken down into absorbable nutrients by your gut enzymes and other juices. When it comes to carbs one has to think of eating unprocessed foods than processed ones. Then, of course, when it comes to carbs there are the resistant starches and fibre containing carbs. These latter non-absorbable forms are beneficial for the health of those microbes in the large gut to protect us from diseases and keep us healthy and boost our immune system.

The absorbed macro-nutrients enter the large veins called the ‘portal veins’ through which all your digested foods enter the liver. The fatty acids have a different pathway through the lacteal system. The portal system starts with many branches called capillaries in the gut and ends in many capillaries in the liver. It is built to carry nutrients in your blood after a meal from your intestines to the liver smoothly.

Like the heart it works like a factory day and night to keep you healthy. It looks after your metabolism, controls your blood lipids including cholesterol, removes toxins you eat through a detoxification process, fights infections and sends the bad stuff through your blood to the kidneys to be excreted.

How can you damage this wonderful factory you possess in your abdomen hidden under the diaphragm, more on the right side?

The liver is not a palpable organ on breathing deeply in and out and gently keeping your hand with stretched fingers, as the doctors normally do to check your liver. If the tips of your fingers touch the lower edge of the liver when deeply breathing out, then we call it a ‘palpable liver’.

In such a situation, the doctor will do many investigations, such as blood tests to check your liver functions, ultra-sounds, CT scans and MRIs, and so on.

An ultrasound is requested by a physician to determine the underlying cause of elevated levels of liver enzymes such as alanine transaminase, or ALT, and aspartate transaminase on doing liver function test on a specimen of blood

When the liver gets hurt it tends to swell. It is composed of millions of cells called hepatic cells and in between they are cushioned with fibrous (interstitial) tissues. When the hepatic cells swell due to infections like viral and bacterial infections the whole organ swells and disturbs its functions. When the tissues between cells gets damaged you get scarring called ‘fibrosis’.

At all times liver cells and the tissues in between must be kept healthy. With progressive disease the changes may not be reversible and may lead to hardening called cirrhosis and finally ends in liver failure.

What is bile

Bile is a complex fluid containing water, electrolytes and other organic molecules including bile acids, cholesterol, phospholipids and yellow coloured pigment bilirubin. Bile is excreted from the liver cells all the time and is stored in the gall bladder to be used at the time of consuming fatty food. It digests and absorbs fats and fat -soluble vitamins in the small intestines. Bilirubin is a waste product from the breakdown of red cells through haemolysis and excreted and eliminated in the feces.

When your liver inflames we call it hepatitis. In situations where excessive bile is secreted during inflammations of the liver or cause some obstruction to the outflow – your eyes (conjunctiva) tends to get yellow, your skin can feel itchy, and you’ll have early nausea and vomiting, loss of appetite and pain in your belly.

These are early symptoms of liver damage you should be aware during the early stages.

There is a condition called ‘Acute liver failure’ which can take only weeks or even days and it can be life-threatening, but most other conditions are chronic- meaning the onset of the disease process is gradual.

Liver diseases may be related to diseases, but also lifestyles that cause chronic damage as in fatty liver due to alcohol and consuming too much of sugary drinks.

Obesity could be one of the biggest concerns for liver disease. Putting on excess weight from eating food with added sugar, and lack of exercise, can give you a non-alcoholicfatty liver disease. In the early stages this is harmless, and most people do have it. Drinking too much alcohol produces an ‘alcoholic fatty liver disease. Both kinds of fatty liver may end up with hardening of the liver we call cirrhosis.

In early stages of both fatty livers often have no symptoms, so it remains undetected until it becomes more difficult to treat.

Now, studies have shown that gut bacteria release a compound may aid early diagnosis

When fat accumulates in the liver it interferes with the normal functioning. The people who are more prone to catch the disease include those with obesity, high blood pressure and type 2 diabetes.

So, if you wish to have a healthy liver eat less food containing added sugar, like corn syrup, eat a low carb and low-fat diet, with minimal alcohol consumption (2 drinks a day for males and one drink a day for females). Exercise daily and contemplate on a healthy lifestyle.

There are drugs and chemicals and even supplements that can cause severe liver damage. Check with your family doctor before you venture on any herbal and nontraditional supplements for better health.

Hepatitis may come in the form of A, B and C. Hepatitis A is from a virus and you will recovery fully within few weeks with care and rest. Do not share needles, have unprotected sex, or live in areas where food and water are not safe.

Look after your gut microbes to boost your immune system all the time. You need to consume probiotics daily and high fibre prebiotics to feed the microbes.

Your liver can get damaged due to autoimmune conditions and the condition is called autoimmune hepatitis.

There are multitude of ducts carrying bile away from the liver. These ducts can get blocked due to chronic inflammation and cause blockage due to scarring preventing bile being excreted into your intestines. It is called Primary sclerosing cholangitis and can cause severe hepatic cell damage. It is rare and is called Budd-Chiara syndrome.

In some situations, gall stones can block these bile ducts and cause liver damage.

Cancer of the liver Cancer can start within the liver and any tumour of the liver is referred to as a ‘hepatoma’. If the liver is damaged from fatty liver disease, cirrhosis, and any chronic liver disease the chances of contracting cancer are very high.

If you suffer from any liver disease, please get yourself examined and investigated regularly to detect early cancer.

You could get secondary cancer spread from other organs like the large bowel or prostate gland in males.

Genetic conditions

There is a rare liver disease which shows in babies or not until 40 or 50 years later. It is called Alpha-1antitrypsin deficiency. In this condition our body does not make enough of a special protein that protects against liver damage.

There is a condition called, ‘Hemochromatosis’ caused due to a build-up of iron in your liver. When too much of copper builds up in your liver the condition is referred to as Wilson disease.

Conclusions: This is only a brief account of liver affections. The lesson we all learn is that we should be aware of liver diseases and attempt to prevent them. Most hepatitis conditions, and fatty livers are preventable. Alcohol consumption should be controlled, and your weight needs regular check and restrict all forms of sugar, and that alone could damage your liver.

(Some reference to Visual Guide to Liver problems-WebMD)



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Alcohol and Its Health Benefits – By Dr. Harold Gunatillake (Health Writer)

Drinking in moderation can be healthy.

It is generally believed that white people drink more alcohol than the non-whites and live longer. Sri Lankans from pre-historic times have been drinking local brews, but the influence of Buddhism deterred drinking in public. When the Portuguese arrived and settled along the western coastal areas, native Sinhala people had observed that these foreigners were ‘drinking blood,’ not knowing that it was alcohol, possibly red wine. Arrack became the social drink among the middle and lower classes of Sri Lankans and the rich and the affluent indulged in foreign liquor from the time of the British.

Today, in Sri Lanka even the ladies drink wines and hard drinks among the upper social classes, and the average working class and rural women do not seem to drink alcohol.

“French paradox” created interest in finding out why the French despite eating a rich diet and drinking wine with meals, had a lower incidence of heart disease. They don’t seem to drink water at all, and the theory that one should drink six glasses or more goes for a six when it comes to the French.

Research and studies reveal that alcohol’s link with health is a bit like Dr. Jekyll and Mr. Hyde. Exactly which face it shows depends on who’s drinking and how much. Most people who drink two or less alcoholic beverages seem to benefit in overall health, including cardiovascular health especially in the middle age when heart disease begins to account for an increasing incidence of morbidity and mortality, while those who drink more are liable to run the risk of colon and breast cancer.

It is also observed that heavy drinking runs the risk of developing high blood pressure, cirrhosis, incidence of various types of cancer and ill-health. Pregnant women should avoid alcohol totally, and others should drink only one per day.

For men the doctors recommend two drinks only. The definition of ‘alcoholic’ is a person who drinks more than what his doctor drinks.

Non-drinkers, however, need not feel the need to start drinking alcohol to improve their health.

For people with liver disease, taking one or more medications that interact with alcohol, the risk of drinking outweighs the benefits. People on chemotherapy should check with their oncologists.

Those who drink even two drinks a day need to take multivitamins with folic acid. Folic acid is a synthetic form of folate, a B vitamin that may help lower the risk of heart disease and cancers of the breast in women and cancer of the colon. Alcohol generally depletes our body’s stores.

When you drink moderately (two glasses) — whatever drink you like — beer or spirits, each seems to have the same health benefits as long as moderation is adhered to (no more than one drink per day for women and no more than two drinks per day for men).

Excessive alcohol drinks may affect your skin giving such diseases like urticaria, porphyria, flushing, rosacea bruising, increased pigmentation, among others.

Heart disease

Maximum benefit in helping to prevent heart disease comes from a regular pattern of drinking small amounts of alcohol. This benefit is noted among people aged from about 40-60 years and over. A similar benefit has not been found for younger age groups. Consuming large amounts of alcohol will have a detrimental effect on your health and increase the risk of illness and death from heart disease. There is strong evidence that low risk drinking may similarly provide some protection against ischaemic stroke, and also provide some protection against gallstones. An exhaustive review of all major heart disease studies found that “alcohol consumption is related to total mortality in a U-shaped manner, meaning moderate consumers have reduced mortality compared with total non-consumers and heavy consumers.

An extensive review of recent medical research by the National Institute on Alcohol Abuse and Alcoholism found that, with few exceptions, studies from at least 20 countries around the world demonstrate a 20 to 40 percent lower coronary heart disease (CHD) incidence among drinkers compared to non-drinkers. Moderate drinkers exhibit lower rates of CHD-related mortality than either heavy drinkers or abstainers.

In a study of nearly 88,000 men, Harvard researchers found that drinking reduced the risk of coronary heart disease risk among both diabetics and non-diabetics. Weekly consumption of alcohol reduced CHD risk by one-third (33%) while daily consumption reduced the risk by over half (58%) among diabetics. For non-diabetics, weekly consumption reduced CHD risk by 18% while daily consumption reduced the risk by 39%.

Harvard researchers concluded about coronary heart disease that “Consumption of one or two drinks of beer, wine, or liquor per day has corresponded to a reduction in risk of approximately 20-40%.”

Moderate drinking reduces the risk of both heart disease and death by heart attack; studies have found variable risk reduction rates, ranging from 25% (various studies) to 40% (Nurses’ Health Study — a longitudinal study of 85,709 nurses).

Alcohol decreases LDL (bad) cholesterol and increases (good) HDL cholesterol. Alcohol decreases thrombosis (blood clotting) by reducing platelet aggregation, reduces fibrinogen in the blood which helps clotting, and increases breakdown of fibrinogen (fibrinolysis).

Alcohol reduces coronary artery spasm in response to stress, and increases blood flow. It reduces blood pressure and reduces harmful arterial plaque.
There is some early evidence that low risk drinking may provide some protection against type 2 diabetes. (Source National Health and Medical Research Council (NHMRC) (2001). Australian Alcohol Guidelines: Health Risks And Benefits. NHMRC, Canberra).

Strokes: A study published in the Journal Of The American Medical Association found that consuming one or two drinks a day can reduce the risk of ischemic stroke by about half. Its findings support the National Stroke Association Stroke Prevention Guidelines regarding the beneficial effects of moderate alcohol consumption.

Moderate drinking and obesity

This is a study conducted at Boston’s Brigham and Women’s Hospital, and published in the Archives of Internal Medicine.

In the study co-researcher Howard S. Sesso ScD, MPH, said that women who already drink in moderation showed a reduction in weight. The study included more than 19,000 women aged 39 and older enrolled in the Women’s Health Initiative.

None of the women were overweight when they entered the study, and all were asked about their daily alcohol consumption in an initial questionnaire.
About 40% reported that they did not drink at all, while 33% reported drinking the equivalent of about two alcoholic beverages a week. Another 20% reported having about a drink a day, 6% drank one to two alcoholic beverages a day, and 3% reported drinking more than this.

Over an average of 13 years of follow-up, most of the women in the study gained some weight.

But the women who reported being teetotalers when they entered the study gained the most weight. The women who reported drinking some alcohol, but no more than two drinks a day, gained the least.

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