Dr harold Gunatillake


What are Ketones and Keto Diet- Is it confusing-By Dr Harold Gunathilaka

Is keto diet though popular as a weight reduction method, is it superior to other standard weight management plans?

Are there health risks involved including nutritional deficiencies in a keto diet?

That’s what we are going to discuss today.

Sri Lankans eat rice and curry as the staple diet. This is a balanced diet consisting of a large amount of carbs as rice, or a few slices of bread and spicy curries to accompany. Curries such as the veggies, fish, meat or the salty dried fish with an occasional egg curry, provide the required proteins, fats and other micronutrients.

The answer to the Western salad, Mallum’. It is a bevy of greens wilted, spiced and combined with shredded coconut amongst other spices. Onion pickle is always there on the dining table as a ‘rice puller’ that feed the microbiota in your gut.

This would be the ideal diet for the hard-working labour class of person who need much sugar to provide quick energy to burn, required for the heavy physical work they perform.

They have no weight problem as such, and the majority remain skinny.When it comes to the affluent sedentary class of people, having a weight problem need to seek dietary restrictions to reduce their body weight. Then, they think of starting on a fancy weight loss diet.

The new keto diet seems to be catching up and considered to be the most beneficial way to quickly lose weight.

Now let’s find out the nitty gritty of this slimming diet.

Ketosis and ketone bodies

We need to know what ketosis is, to understand how the keto diet works.

Ketosis is a normal process that happens when your body doesn’t have enough carbs to burn for energy. Instead the fat reserves in your body starts mobilising to provide energy through a substance called ketones.

This is a life-saving natures method or call it a ‘survival kit’ when you get lost in the jungle for many days deprived of food or during starvation.

Ketosis is a popular weight loss strategy where you reduce your carbohydrate intake to 50 gams daily. Usually in your normal balanced diet you do consume as much as 200 grams of carbs mainly as rice or bread. Keto diet is a low carb diet like the eating plan which was propagated by Atkin and in the Paleo diet which stress proteins and fats for fuelling your body. The idea is for you to get more calories from protein and fat and less from carbohydrates.

The low carb, high fat keto diet causes the metabolic state known as ketosis, in which substances known as ketones or ketone bodies accumulate in your blood.
When you start on this low carb diet ketosis kicks off in after 3 to 4 days of eating less than 50 grams of carbs per day.

50 Grams of carbs is 3 slices of bread, or two tablespoons of boiled rice, a cup of low-fat fruit yogurt and two small bananas.

So, when you cut back on your carbs, fat in your fat cells stored as triglycerides,seem to mobilise and used for energy through ketone body formation in the liver.The liver produces three ketone bodies. They are: Acetoacetate, beta hydroxy butyrate and acetone. To go further, these ketone bodies are formed from acetylCoA found in the mitochondrial matrix of liver cells when carbs are scarce that energy must be obtained from breaking down of fatty acids.
In addition to recommending the keto diet for weight loss, it is also recommended by doctors for children and adults having epilepsy- a special high fat diet which seems to prevent seizures.

Keto diet may help people with heart disease, and certain brain diseases and acne, but there needs to be more research in those areas.
Some researchers suggest that keto diet might help lower the risk of heart disease, though the intake of fats is high. Other studies show that this diet with low carbs can help people with metabolic syndrome, insulin resistance as among type 2diabeticsWhen you start on a low carb diet, especially Sri Lankans who indulge in large quantities of rice in their daily consumption, may feel bad and restless during the first week on this diet. This is due to sugar and carbs withdrawal.

Keto diet includes high fat foods where one can eat up to 70-80% fat, and proteins and restrict carbs. Most keto diets include processed meats, fatty cuts of meat,including red meat, lard and butter. Unsaturated fats like oily fish, nuts and seeds and plant oils are also included.

Keto diet avoids all carbs sources including both refined and unrefined products.Foods to avoid include all breads, including whole grain, cereals, pasta, cookies and baked goods, rice, starchy veggies like corn, and potatoes, and fruits and their juices.

The side effects of keto diet could be – headache, fatigue, brain fog, irritability, constipation and so on. Low carb diets can lead to kidney stones or high levels of acid in your body called

If you have uncontrolled diabetes, ketosis can become dangerous when the ketone body build-up is high. It may lead to dehydration and change in the body chemical balance of your blood becoming acidic may result in a coma or death.

This condition is called diabetic ketoacidosis (DKA), when your sugar level is very high in your blood when you don’t take enough insulin to control your blood sugar level.

So, please control your blood sugar levels before you plan to start on a keto diet, if you are a diabetic.

Some people without diabetes can get ketoacidosis, too., due to heavy alcohol intake, starvation, or an overactive thyroid.

Should diabetics go on a keto diet because of the forced low carb intake? Mice experiments have revealed that keto diet may increase the insulin resistance, i.e. poor glucose tolerance, and yet it does seem to question the safety of excess fat that is consumed on the keto diet.

So, presently, the advice given to the diabetics is to be vary of going on a keto diet because of the low carb intake.

Red Meat: Eating more red meat may shorten your life People who increased their red meat intake by just half a serving a day boosted their risk of dying over the next eight years by 10%, the study authors said.

Processed meats are dangerous Processed meats are smoked, cured, salted, canned, dried, or preserved. Cold cuts, hot dogs, bacon, sausage, salami, beef jerky, ham, corned beef, and other processed meats are linked to a variety of health problems. In several studies, people who ate the most processed meat had higher rates of diabetes, heart disease, and some types of cancer. Excess salt, preservatives, and fat in the products are to blame. Eat more meatless meals, cut back on the amount of processed meats you eat, and up your intake of fruit and veggies to protect your health.

It is important that you need to take enough dietary fibre for gut health and wellbeing. Fibre itself is a carb that the human gut cannot digest. Therecommended daily intake is 25 grams for women and 38 grams for men Sri Lankans get more fibre from tropical fruits like jack and breadfruit and theveggies. Jack provides in one serve 2.5 g of fibre. Jack fruit is also rich inantioxidants eliminating the toxins produced by the body as well as the free radicals
which harm for us. Such toxins and free radicals formed in the body daily is known to cause cancer.

Breadfruit has 4.9 g of dietary fibre i.e. 13% of your daily requirement.

It is a starchy fruit and you are deprived if you are on keto diet.

High protein and high fatty foods have no fibre. Red meat has no fibre.

Fibre is a prebiotic that the microbes in your gut feeds on and produces butyrate and other short chain fatty acids that protects your gut inner lining from chronic debilitating diseases like Crohns, ulcerative colitis, and cancer.

In keto diet the fibre intake is low, and that may be detrimental to your health and wellbeing.

It is sound advice to eat a balanced low calorie low dense diet, exercise daily at least walk 10,000 steps a day and limit your alcohol consumption. Focus on eating unprocessed carbs like brown rice and multigrade bread That would be the long-term regime to control our weight.

Just imagine you are carrying a sack of potatoes on your shoulder and walking about. If you have put on that amount of weight, your body must carry that amount daily. That would put a strain on your heart, joints and more.

Hope this talk was useful. Now please enjoy the you tu.be
My new website: www.doctorharold.com

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The Way Heart Works-By Dr. Harold Gunatillake

Keep your heart rate between 60 to 80 beats per minute

If you use an average of 80 beats per minute, your heart beats about 4,800 times per hour. That’s a whopping 115,200 times per day. Over the course of a year, your heart would beat about 42,048,000 times!

Let’s listen to a healthy steady heartbeat.

That is the way you must keep your heart beating through life. Take care of your heart and your heart will give you a healthy good lifespan.

Athletes and others who do strenuous exercises, may bring down their heart rate according to the extent of training. Olympic athletes bring down their heart rate to 40 beats per minute, for competitive performance

If you are sedentary, your heart rate may go up to 90 per minute, or more

If your heart rate is more than 90 beats per minute you need to see your doctor to check the reason. In such a situation if you neglect your heart may go into failure without your knowing or may have a stroke or sudden arrest and death.

To be on the safe side, please check your pulse at your wrist, or side of neck, regularly at rest. During exercise it raises physiologically.

When the heart rate is rapid, we call it ‘tachycardia’ Sinus tachycardia is when the heart rate increases due to physical activities. In such situations, the increased rate does not harm your heart

Your heart rate may be regular or irregular. It may be irregular due to a dropped beat. Please see your doctor early.

Your heart rate gets rapid if you are malnourished and anaemic. This is the commonest cause of tachycardia among many rural people in Sri Lanka. They need a nourishing diet to make the heart work healthily.

Frequent coffee drinkers have a rapid heart rate. If you eat chocolate bars daily, your heart becomes rapid due to the stimulation by the caffeine in the chocolate,There is a term called inappropriate sinus tachycardia. About half of the time, this phenomenon occurs after recovery from a serious illness, usually a viral illness. And most often, those affected are women in their 20s and 30s.

Inappropriate sinus tachycardia does not damage your heart.

The commonest cause of rapid heart rate is Atrial fibrillation. The term atrial or atrium is used for the upper two chambers of the heart and the term ventricle is used to the lower two chambers.

When you go for your blood pressure check- up, in addition to upper and lower readings, the pulse rate is as important in the management of high blood pressure So, remember to know your pulse rate i.e. your heart rate, when you next visit you doctor.

Atrial fibrillation may be due to irregular electrical impulses in the two upper chambers or atria.

This raised irregular heart rate may be due to some heart disease, high blood pressure, heart valve disorder, increased thyroxine hormone liberated from your thyroid glands in your neck, we call it hyperthyroid state.

If you have an over-active thyroid there are other symptoms like, loss of weight even when eating lot of food, thin and moist skin, bulging eyes, loose motions, tremors in your fingers and so on.

Heavy alcohol abuse is another cause of rapid heart rate. Now let’s talk about irregular heartbeats- doctors call it Arrythmia.
You may feel that you are skipping a beat, or having added a beat When there are added beats, we call it “flutter”

When the beat is irregular the rhythm may be fast or slow or too early. Many arrythmias are harmless and many people live with it.

It could be harmful too-then it is serious-may be due to damaged heart and you must see your doctor immediately.

With irregular heartbeat if you feel dizzy, breathless or feel rapid heartbeats we call
palpitations – then it is serious. The causes of irregular heat-beats are:
• alcohol abuse
• diabetes

• drug abuse
• excessive coffee consumption
• heart disease like congestive heart failure
• hypertension (high blood pressure)
• hyperthyroidism (an overactive thyroid gland)
• mental stress
• scarring of the heart, often the result of a heart attack
• smoking
• some dietary supplements
• some herbal treatments
• some medications7
• \
If you feel a burst of fast irregular heartbeats lasting for a few minutes to a few
hours and back to normal – this condition is called Supraventricular tachycardia. For this condition there are medications like beta-blockers and calcium channel blockers. Many people with this condition have a procedure called catheter ablation. The other irregular heartbeats are:

Atrial flutter,AV nodal re-entrant tachycardia
Ventricular tachycardia, ventricular fibrillations, and so on. The bottom line is – you need to check your heartbeat i.e. your pulse rate in your neck or wrist occasionally. You may even experience palpitations, dizziness, fainting attacks.

You need to see your doctor immediately and take remedial measures before your heart goes into failure.

The bottom line is- If you feel that your pulse rate in your wrist or the neck is rapid, very slow, or irregular, you must see your doctor as soon as possible.Hope this talk was useful. Until we meet again, Goodbye.


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Let’s Talk about Mental Health Today – by Dr. Harold Gunatillake

It has been shown that playing mental sports like chess lowers the risk of dementia by 74% according to studies conducted by the researchers at the Albert Einstein College of Medicine.

Neuroscientists agree that in addition to proper diet, fitness memory can be improved by learning something new to sharpen your brain over the years.

Sri Lanka has paved the way to the world how playing chess at a young age or other challenging mental sports do lower the risk of developing dementia as mentioned earlier, as much as 74%.

School going children and young adults from 800 families, a few from abroad, being members of the 64 Squares International Chess Academy, had their annual chess championship in August in Kandy, Sri Lanka from the 22nd of August for a week, ending with a grand finale of speeches, dance performances, and the prize distribution to the runners-up and the champions in each grade, on the 27th August, at the Oak Ray Regency Hotel, having one of the best function centres in Sri Lanka for such large scale events.

It is their 10th encounter naming as the 10th edition of the “Kandy Open Chess Festival”, considered as the biggest International Chess Festival.

It has been revealed and published in the scientific journal Nature on the topic “Neuroplasticity: Changes in Grey Matter Induced by training by playing mental sports like chess, 15 minutes daily for a period of three months resulted in a significant increase in the brain’s grey matter.

Please enjoy the video and share with others. Send your children for chess one of the best mental sports to prevent memory loss in their old age.

Thank you

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Osteoporosis is a silent disease-By Dr Harold Gunatillake

Your bones in the body,especially those that are weight bearing such as the spine, and hips should be strong to carry out everyday functions. When you are young, they are strong, engaging in activities such as sports and being active, keeps the bones strong.

Age being a risk factor, leading a less active life, and especially among women when they reach their menopause with low sex hormone, tend to soften their bones being more porous and the density and the quality of the bones weaken and become more fragile due to accelerated bone loss, that occurs after menopause.

This condition is called osteoporosis of the bones which is a silent process without early warning symptoms. In the US. there are over 10 million suffering from osteoporosis and another 44 million suffering from low  bone mass called osteopenia, according to the National
Osteoporosis Foundation.

Our bones are constantly changing, developing and strengthening and are most dense, in our twenties. As we age some of the mineral contents gets depleted and the bone cells begin to dissolve the matrix of the bone, called resorption while new bone cells are formed to
replace them. This process is called remodelling.

In youth there is a balance between resorption and bone formation, but with age the bones become porous, brittle and prone to fractures.

Asians, including Sri Lankan men and women being of smaller stature and leading sedentary lives have a very high incidence of hip fractures-meaning fractures of the neck of the femurs with the slightest fall. They also have less bone to lose than people with larger frames and more body weight.

Also common among Asians including Sri Lankans, are the spine and wrist fractures.

We are born with about 300 soft bones and with age the cartilage attached to them gets replaced by hard bone. Some of these bones later fuse together, so that an adult skeleton has 206 bones.

The structure of our bones consists of a hard-outer layer  called the cortical which is strong and tough, and an inner spongy layer called the cancellous bone.

Bone forming cells are called osteoblasts and the bone resorbing cells are called osteoclasts. Osteoblasts seem to work most efficiently to form bone around the age 30 for both sexes. When you are about 35 years bones breakdown faster than new ones being replaced. In
short, osteoclastic activity takes over from the efficient osteoblastic activity, causing a gradual loss of bone mass.

Women seems to undergo more rapid osteoclastic activity -that is bone loss in the first few years after menopause, as less oestrogen is secreted in the ovaries that enhances the bone formation.

Nutrition-wise, low calcium intake and low vitamin D levels in the body can lead to bone loss. Vitamin D helps to absorb calcium from your food and participate in the structure of the bone.

To prevent osteoporosis, you need to consume adequate amounts of food rich in calcium and vitamin D throughout life.Foods such as seeds, cheese, yogurt, sardines and canned Salmon, beans lentils, leafy veggies provide enough calcium and vitamin D.

You could boost your increase of vitamin D levels by spending time in the sun, consuming fatty fish and seafood, eating more mushrooms, egg yolk and supplements.

There are certain dietetic risk factors to think of, if you have osteoporosis. Eating salty foods, drinking too much soda, and spending most of your time indoors are among habits that should be avoided. A healthy diet as described earlier with exercise, among other things, can
help to prevent the risk of osteoporosis.

Daily exercise is important to keep your bones strong. Walking 10,000 steps a day would be enough. For some regular workouts that include weight-bearing aerobic activity and strength training in a Gym workout is recommended.

There are certain drugs usage long term can lead to osteoporotic bones, such as corticosteroids. Heparin, blood thinners, antidepressants, aromatic inhibitors used to treat breast cancer.

Alcohol abuse and smoking are also cause for osteoporosis. You could get osteoporosis of the bones, after being bedridden for a few weeks after any debilitating illness

There are no symptoms during the early stages of osteoporosis. Loss of height and a curve in the upper back may be early signs.

Your doctor will do a bone mineral density test (BMD) if he suspects you have osteoporosis. The test uses special X-ray machine to measure the mineral content at three different bone sites.

This test is recommended to women over the age of 50
years. The drug of choice for osteoporosis is Bisphosphonates.The others include alendronate (Fosamax), risedronate (Actonel) and ibandronate (Boniva). Studies have shown that alendronate can reduce the risk of spine and hip fractures by up to 50%.

For advanced osteoporosis your doctor may prescribe injections, includes teriparatide (Forteo), abaloparatide
(Tymlos) and romosozumab (Evinity). In addition to above medication you may have to take 1,200 milligrams of calcium per day from food or supplements.

Being active, and participating in sport activities during you school days, exercising daily and eating the right foods will prevent this disabling disease.
Ref: Article by Carl Nierenberg -Live Science Contributor

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What should be the normal Blood Pressure for a Sri Lankan By Dr Harold Gunatillake

The blood pressure that is considered normal for men and women seems to be changing
from time and again. When we were medical students in the fifties, we were told that the
upper pressure should be less than your age plus 100:
meaning, if you are 50 years, your normal systolic pressure should be 150mm.Hg or less.
With time, studies revealed that the incidence and the risk of heart disease and stroke was
quite high with such blood pressure readings.

Blood Pressure

Then, it was realised that the strain on the Heart muscles with this respective BP considered
normal, was too severe, resulting in high incidence of heart problems, including failure.        

The blood pressure of an individual depends on the force of blood ejected from the left lower chamber (ventricle) of the heart against the resistance of the peripheral arteries and the rate of pumping (pulse rate).          

The medications prescribed for hypertension by the doctors, consider all these three factors in your blood pressure management.

If the systolic pressure is too high a peripheral Vasodilator alone may bring down the
BP in the early stages.
How this works is that lowering the peripheral resistance, you reduce the force of
the ejection of blood from your heart, referred to as the ‘systolic pressure’
The more popular drugs used to bring down the pressure is the Angiotensinconverting enzymes (ACE) inhibitors, help relax blood vessels and also prevents anenzyme in your body from producing angiotensin 11.

The other drug is angiotensin receptor Blockers (ARB) As said earlier these drugs widen or dilate your blood vessels and releases the pressure on the heart.

Then, doctors prescribe calcium channel Blockers. They work by slowing the movement of calcium into the cells of the heart and blood vessel walls. Heart muscles need calcium to contract.

If the heart rate is rapid, in addition to high blood pressure, your doctor will prescribe a beta blocker that lowers the BP in part by decreasing the rate and force at which the heart pumps blood.

This explains the modern methods of bringing down the high blood pressure and the doctors modulate them as required.

It was considered for a few decades that the systolic BP of a Sri Lankan person should be maintained below 120mmHg and the diastolic pressure at 70-80mmHg.

The European Society of cardiology has changed the baseline to 140/90 from the existing 130/80mmHg. This baseline BP applies to people over the age of 60, and those below the baseline is considered as 130/80 Sri Lankans are smaller in stature and strength compared to the Western men and
women, and it is reasonable to maintain the pressure for men as 120/70-80mgHg and for women- systolic as 110mmHg and diastolic as 70mmHg. This should apply to all ages- young and the old.

Such lower pressures maintain the cardiovascular system in prime condition, lowering the risk of heart attacks and stroke.
It is very important that diabetics with chronic kidney disease should adhere to such low pressures.

Sri Lankans should maintain systolic and diastolic blood pressures much lower than those recommend by the European Society of Cardiology which applies to the Europeans.

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