Dr harold Gunatillake


Chronic Kidney Disease that You Should Know About-by Dr Harold Gunatillake

Presenter-Dr. Harold Gunatillake FRCS, MB,BS, AM (Sing), FACS, FIACS


WE are all concerned about our heart-health and cholesterol levels, whilst a silent disease may be brewing up in your kidneys, without symptoms for years.

So, how can we find out whether our kidneys are healthy or otherwise.

Chronic Kidney Disease (CKD) affects 11% of the US population- that is 30 million Americans have CKD. Additional millions are at risk.

Early detection can help prevent or control the progression of CDK. In short slow down the disease in moderately advanced situation.

In Sri Lanka, it is referred to as the silent Killer, and is common in the North Central and Uva Provinces, affecting more than 15% of the population. This includes children and females, in addition to affecting farmers using pesticides in the paddy fields

It is important to understand and know the lab values if you suspect chronic kidney disease

Creatinine is a waste product that is formed in the muscles from creatine phosphate and from consumed red meat.

It is excreted in the urine, but in chronic kidney disease it gradually accumulates in your blood.

If you suspect chronic kidney disease your doctor will check on the blood creatinine level.

If the kidneys aren’t working well, the serum creatinine level gradually rise, and gives an estimate of how well your kidneys filter. We call this glomerular filtration rate. Also, we call it GFR which is calculated based on your serum creatinine.

In other words, GFR is the rate at which the kidneys filter toxins from the blood.

Glomerular filtration rate GFR- an important test to assess the functions of your kidneys.

GFR Number correlates with the overall kidney function

This number fluctuates from day to day. In normal kidney functions it is always over 60

If the number is 40, it means that your kidney function is on an average 40 %. This of course is a rough estimate and referred to as stage 3 state.

Normally when you are dehydrated from not drinking enough water, as we all do, creatinine level may rise temporarily. So, drink plenty of water when you go for this test.

Do not eat too much of meat or take certain medications or exercise, when you go
the next morning for your serum creatinine test.

Another test your doctor may request is the blood urea Nitrogen called BUN test.
This is less reliable than the creatinine test.

Kidney failure is also called the End-stage failure.

Diabetes is the most common cause of kidney failure
180 litres of blood are filtered through the kidneys daily, to produce 2 litres of urine.

It is a process of selective filtration which removes waste and potential toxins from
the blood.

If you have one kidney that kidney will filter the same amount of blood.

If a kidney gets damaged, how can the same amount of blood go through the
kidneys when blood vessels are injured?

Yes, the body compensates by raising the blood pressure to force the same amount
of blood through the damaged kidneys.

We say, that damaged kidneys produce high blood pressure. So, the doctors give drugs to lower the blood pressure and then the kidneys may not be able to filter all the waste products and toxins.

How does diabetes cause kidney disease?

Diabetes is the leading cause of kidney disease. About 1 out of 4 adults with  diabetes has kidney disease.

Increasing uncontrolled blood sugar seem to damage blood vessels, including those in the kidneys.

In the kidneys the minute blood vessels get inflamed and the term vasculitis is used. 

Blood vessel damage such as thickening -we call arteriosclerosis can lead to high blood pressure which can also damage your kidneys.

Kidneys don’t show damage during the first 10 years having diabetes. About 15 to 25 years will pass before kidney failure occurs.

Controlling your diabetes, that is monitoring your blood sugar may help you keep your kidneys healthy.

Arrange a diabetic diet plan with a dietitian.

Avoid eating foods with high salt. 
Exercise daily- 10,000 steps walk
Keep your weight at healthy level.
Get enough sleep.

Metabolic functions of the kidneys

Kidneys play an important role in the metabolism of carbs, proteins, lipids and other nutrients.

Kidney tubules generate glucose, clears insulin from the circulation, perform critical steps of the urea cycle and regulate the metabolism of fat- soluble vitamins such as A and D,

In chronic kidney disease, these functions will be disrupted and may cause cardiovascular disease.

Kidney maintains the micronutrients like the minerals within the normal range.

For instance, Calcium and Phosphorus are needed for bone health. High levels of parathyroid hormone can imbalance calcium and phosphorus and lead to bone diseases.

Other minerals like sodium, potassium is important for nerve and muscle functions, including heart muscle.

Bicarbonates maintain acid base balance in blood.

Now you’ll realise the importance of properly functioning kidneys to prevent diseases.

Symptoms of kidney disease.

In the early stages in stage 1 and 2 there are no symptoms, and this may last for 10 years.

During these stages you may need blood tests to check on your creatinine level to check for kidney disease.

So, it is important when you are over 60, to do a kidney function test on your blood sample.

In stages 3 and 4 there are certain symptoms and in stage 5 most symptoms are seen, and this would be the stage that you require dialysis.

Stage 3 is the commonest stage seen by doctors. The GFR would be between 30 and 59.

At this stage you’ll have fatigue, swelling around ankles and frequent urination In stage 4 the GFR is between 15 and 29 when in addition to the symptoms in stage 3, loss of appetite and shortness of breath will be seen.

Stage 5 is the most severe stage when GFR comes down between 5 and 15.

The symptoms in this last stage are

• Trouble sleeping,
• Worse concentration,
• Nausea,
• metallic taste,
• vomiting and
• muscle cramps.
• Blood pressure will rise at this stage and your doctor may have to add a
second antihypertensive drug.
• Your sugar level will be low at this stage.

The bottom line is be aware that certain drugs and chemicals will damage your kidneys when taken for a long time, such as anti-inflammatory drugs, Aspirin, Panadol, alcohol, antibiotics, certain laxatives, illegal drugs, contrast dyes used in X rays, ulcer medicine such as cimetidine, heartburn medications, pesticides, insecticides and so on.

If you are a diabetic, tightly control your diabetes to prevent diabetic kidneys.

I hope this talk was valuable.

Stay healthy and good luck.

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Diabetes – can you reverse the malady-Is there a natural therapy? – By Dr Harold Gunatillake

May require headphones

Let’s discuss about diabetes briefly before we find the answer to the claim by some authorities that there is a cure for diabetes.

Let’s keep our discussion to type 2 diabetes only, meaning the type of diabetes healthy people get during adulthood, after the age of 40, for some unknown and known reasons.

The number of people with diabetes has risen from 108 million in 1980 to 422 million in 2014. The global prevalence of diabetes* among adults over 18 years of age has risen from 4.7% in 1980 to 8.5% in 2014. Diabetes prevalence has been rising more rapidly in middle- and low-income countries.

China, India and the United States top the list for the most cases of diabetes per country; around 24.4 million Americans had the disease in 2013. But islands in the Pacific have the most alarming rates of prevalence, or the number of cases compared to the country’s population overall.

Sri Lanka too is seeing an increase in the cases of diabetes. According to recent statistics by the International Diabetes Federation (IDF), the prevalence of diabetes among adults in Sri Lanka is 8.5%. At present, one in 12 adults in the country suffers from diabetes, which totals to 1.16 million.

What happens to the carbs like rice, bread, sodas and fruit drinks, you consume daily in your body?

Your body breaks down carbs and starches you eat into sugar called glucose in your gut, used for quick energy. Insulin, which is made by your pancreas, helps keep the right amount of glucose in your blood stream.

If you do not have enough insulin manufactured in the pancreas, your blood sugar level will rise.

Blood sugar level is less than 100 mg/dL after not eating (fasting) for at least 8 hours. And is less than 140 mg/dL 2 hours after eating. During the day, levels tend to be at their lowest just before meals. For most people without diabetes, blood sugar levels before meals hover around 70 to 80 mg/dL.

A fasting blood sugar level less than 100 mg/dL (5.6 mmol/L) is normal. A fasting blood sugar level from 100 to 125 mg/dL (5.6 to 6.9 mmol/L) is considered prediabetes. If it’s 126 mg/dL (7 mmol/L) or higher on two separate tests, you have diabetes.

Insulin which controls the blood sugar level is manufactured in the beta cells in the pancreas.

With dysfunction of the beta cells due to known and unknown factors, less insulin will be secreted, and the sugar level will remain high in your blood.

Normal function of insulin is to courier the blood glucose to various tissues, cells, including the liver for storage and use for energy.

In certain situations, if you eat too much of carbs, and drinks with added sugars you may stress the beta cells and cause insulin resistance.

Insulin resistance

In insulin resistance your beta cells manufacture more insulin to control your blood sugar. This is a very stressful situation for the beta cells. The resistance increases with age and how can your reduce the resistance to insulin.

Normally, your doctor will increase your insulin injections to lower the blood glucose level with insulin resistance.

This situation is like giving more alcohol to an alcoholic to cure the disease.

The solution is to take measures to reduce insulin resistance, and not increase your

The measures that are available to reduce insulin resistance are:
Exercise daily to burn more blood glucose.

Consume low GI foods, like unprocessed carbs, vegetables, nuts, lentils.

Limit your alcohol consumption.
Take measures to reduce weight, if you are overweight.

Such measures will reduce insulin resistance, and your doctor will get the opportunity to reduce your dose of insulin, rather than increasing.

Unchecked high blood sugar can cause health problems like heart disease, nerve and kidney damage, and eye conditions

Alcohol stops your liver from making glucose. Women with diabetes should have no more than one drink a day and men should have no more than two. Don’t drink on an empty stomach or when your blood sugar is already low. Check your blood sugar before, during, and for the next 24 hours after drinking

Can you cure diabetes?

The answer is with change of lifestyle, and medication, reducing risk factors, weight loss, including stress you could achieve normal blood sugar levels, but permanent reversing is not a possibility.

During the prediabetic phase, you could reverse diabetes by strict dietetic control and daily exercise. Again, reversing the malady is not curing.

Type 2 diabetes is an ongoing disease. Even if you’re in remission, which means you aren’t taking medication and your blood sugar levels stay in a healthy range, there’s always a chance that symptoms will return.

So how can you reverse diabetes? The key seems to be weight loss. Not only can shedding pounds help you manage your diabetes, sometimes losing enough weight could help you live diabetes-free — especially if you’ve only had the disease for a few years and haven’t needed insulin.

With all the research on diabetes and advances in diabetes treatments, it’s tempting to think someone has surely found a diabetes cure by now. But the reality is that there is no cure for diabetes — neither type 1 diabetes nor type 2 diabetes. (Although lifestyle changes can achieve remission in type 2 diabetes in some cases.)

Is there a natural therapy that can cure diabetes?

No. Natural therapies such as deep abdominal breathing, progressive muscle relaxation, guided imagery, and biofeedback can help relieve stress. And emotional stress affects your blood sugar levels. So, learning to relax is important in managing your diabetes.

Supplements don’t cure diabetes, either. Some natural supplements may interact dangerously with your diabetes medication. Others have been shown to help improve your diabetes, but always check with your doctor before taking any supplement.

Be sceptical about claims of a diabetes cure. A genuine cure will have been tested repeatedly in clinical trials with clear success.

When the beta cells start deteriorating in its function, you cannot rejuvenate and revert to normal function.

Supplements don’t cure diabetes, either. Some natural supplements may interact dangerously with your diabetes medication. Others have been shown to help improve your diabetes, but always check with your doctor before taking any supplement.

Be sceptical about claims of a diabetes cure. A genuine cure will have been tested repeatedly in clinical trials with clear success.

Hope this video gave you good advice on the subject.

Thank you for watching.

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Balanced Diet By Present Day Concept

balanced diet









A diet is all that we consume in a day. And a balanced diet is a diet that containsan adequate quantity of the nutrients that we require in a day. A balanced diet includes six main nutrients, i.e. Fats, Protein, Carbohydrates, Fibre, Vitamins,and Minerals. All these nutrients are present in the foods that we eat.
By present day definition a balanced diet should include prebiotics and probiotics for the nourishment of the gut microbiota- your internal friends that looks after yourhealth in all respects and aspects.

Let us first find out what the cave man ate to be strong, tall robust and fit to hunt for his food.

Man is what he eats, goes a famous German saying. So, let us find out what ourstone age people’s delicacies were. Did they have a balanced diet?

These old cavemen lived in caves several thousand years ago in the jungles hunting for their own food daily. They did not have the means to cultivate and grow fruits and vegetables, but lived solely on hunted animal flesh, mostly barbecued or held on
fire to burn.

These prehistoric friends ate meat raw, lightly burnt animal bones and many a hearth excavated by archaeologists testify to a rudimentary knowledge of firemaking and roasting meats From what we can gather from the faunal remains left over from his hearty meals,
Balangoda man was a carnivore to the core.

He loved to gorge on meats of all kinds and was sure a very meaty fellow as a result. Meats gave him the protein he needed
to make his day.

Sri Lankan veddah’s were different. They are aborigines or indigenous people of Sri Lanka. Many veddahs also farmed using chena cultivation and they did kill animals to eat. They never harmed young and pregnant animals.

The staple food, rice, was cultivated in extensive paddy field, while vegetables,greens, grains and cereals were cultivated in rain-fed lands called ‘Chenas’

Veddas are famously known for their rich meat, venison and the flesh of rabbit, turtle, tortoise, monitor lizards, wild boar.

They did have a very balanced diet composed of rice, cereals, nuts, vegetables andanimal flesh.

Meat eating cave man during the Palaeolithic life, did not know that he needs tofeed his inside friends- the gut microbes.

So, you can now explain why the cave man’s Palaeolithic life expectancy was 25

On the other hand, the aboriginal veddahs in Sri Lanka lived longer because of the
variety of food such as rice, vegetable curries, mallung, ambul thiyal, kolakenda,
they consumed daily.

In contrast to the paleolithic cave man, veddah’s had a life span of about 60 or more. They naturally fed their gut microbes with fibre and probiotics.

The Western pattern diet (WPD) or standard American diet (SAD) is a modern dietary pattern that is generally characterized by high intakes of red meat, processed meat, pre-packaged foods, butter, fried foods, high-fat dairy products,
eggs, refined grains, potatoes, corn (and high-fructose corn syrup) and high-sugar ..

It is not a well-balanced diet as it lacks fibre and probiotics and prebiotics not included for the nourishment and wellbeing of the microbiota

A low-carb diet is low in carbohydrates, primarily found in sugary foods, pasta and bread. Instead, you eat real foods including protein, natural fats and vegetables.

Studies show that low-carb diets result in weight loss and improved health markers.

These diets have been in common use for decades and are recommended by many doctors.
This low carb and high fat diet originated from the lifestyles of eskimos.

The Inuit, the native people many call “eskimos” have not eaten carbs in over35,000 years. Somehow, they have managed to thrive. Ever seen a plant growing in the Arctic circle? No? So, no carbs. By the way the word Eskimo means “meat eater.” You don’t say?

Their gut microbial diversity is different from those who eat a high carb, low fat diet.
They do not live beyond 65 years because they have no microbial protection.

Modern diet relates to ‘Junk food’ that simply means an empty calorie food. …Junk food is an informal term applied to some foods which are perceived to have little or no nutritional value, but which also have ingredients considered unhealthy when eaten regularly, or to those considered unhealthy to consume at all.

Any diet regime should promote a healthier gut microbiota

“Low Carb with high fat diet regimes may not be the best to keep your gut microbiota happy and friendly”

Recent studies have revealed that over 100 trillion of beneficial bacteria, viruses and fungi are found mainly in our gut. In addition to looking after your health, mood, metabolism, mental health, autoimmune diseases endocrine disorders, gut-health, providing vitamins, immune system, cancer, and in many other ways, the gut bacteria or microbes as we call them, seem to keep bad bacteria in check.

We need to look after these beneficial microbes for our good health, and how should we do it?

Studies have revealed that gut microbes or microbiome has enormous functional responsibility to the host and the diet plays a fundamental role in the shaping of the composition of gut microbiota.ui4

A new study published in the “British Medical Journal” investigated these requirements of keeping healthy balanced diet as the traditional balanced meal containing high unprocessed carbs, low fat, and a moderate amount of proteins, and not the low carb diet referred to as a ketogenic diet, with high fat intake recommended for weight reduction.

Long term following of such diets may be detrimental for the survival of good microbiota in the gut and most likely result in self-created chronic inflammatory diseases in your body and discouraged according to present day studies.

Keto diets and Atkin types, promoting low carbs and high fat intake to combat overweight problems, may not be the best dietetic regimes, to keep microbial ecology inprime form for our health.

Please take time to enjoy & share the video.

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All about Cooking Oils-By Dr Harold


All cooking oils are not the same

Many years back there was not much of a choice of cooking oils. Lard obtained from pig fat was very popular. I remember in the 1950s in Singapore they used lard in street noodle outlets. Lard has about 40% of saturated fat:50% of monounsaturated fat and 10% of polyunsaturated fat. Smoking point is 218 deg. C. ideal for deep and stir frying. It is low in saturated fat unlike other animal fats, butter, tallow, and high in heart friendly monounsaturated fat.

Today most oils used in street food outlets and hotels is vegetable oils. Lard wasdemonized though much better for health than the faked processed vegetable oils.Lard has a better flavour and texture when used as a cooking oil.Vegetable oils from corn and rape seed which produces canola oil, are cheaper and popular, used for most dishes today.

Fish and chips outlets use vegetable oils. Mind you, when you use any cooking oil as a rule must be discarded after the first usage, because of the free radical formation.The oil that is used in the fish and chips industry, seems to use the same oil repeatedly during the whole day, and from a health point of view, it is best to avoid.Free radicals generally seem to shorten your life.

Today, in the super-markets there is a load of cooking oils, includes extra-virgin oil,coconut oil, sesame oil, peanut oil, grapeseed oil, avocado oil, sunflower oil, and so

For Asian curries and cuisines, coconut oil seems to be the most popular and hasstood the test of time.
Coconut oil is extensively used in cooking fish and vegetables in Asian curries and is very stable, does not go rancid. Coconut oil has a high smoke point andlonger shelf life than some other fats. As it is solid at room temperature, it can be used in baking recipes, for frying, for greasing baking pans and as a replacement for butter or vegetable oil in recipes.
Let’s go deeper into saturated and unsaturated fats.

You are aware that a molecule of water is composed of two hydrogen atoms linked to one oxygen atom.
So, on boiling water at 100 deg. C, you get pure healthy steam.On the other hand, fatty acids that form fats are composed of chains of carbonatoms linked together with a pair of hydrogen atoms hanging on, either side of each carbon atom. You may refer to this as a long hydrocarbon chain consisting of carbonand hydrogen atoms.

All oils have a variable smoking point unlike water that steams at 100cOils vary in their smoking points, and the unhealthy smoke comes from the carbon chains, unlike water when boiling emanates steam. 

Fats are classified as saturated fats and unsaturated fats. A third kind of artificial or synthetic fat is trans-fat.
In a saturated fat, all carbon atom chain is filled with hydrogen atoms linked on each
side of each carbon atom.
Let me describe this in a simpler way.
If you get into the train, and when you look around there are no vacant seats. Thenwe say the train is saturated.
In fatty acids the seats are carbon atoms and the occupant are a hydrogen atom.
When you talk about unsaturated fatsUnsaturated fats are liquid at room temperature.
They differ from saturated fats that their chemical structure contains one or more
double bonds

Unsaturated fat typically comes from plant sources such as olives, nuts or seeds.
Also present in fish.
Unsaturated fat could be monounsaturated or polyunsaturated.
With monounsaturated fat there is one pair of hydrogen atoms missing from a carbon atom and its double bonded
In polyunsaturated – there are many vacant carbon atoms with many double bonds

Nutrients lost in cooking

Cooking at high temperatures in oil and large quantities of water for longer times cause micronutrients in the food to get lost, such as water-soluble vitamins likevitamin C, Thiamine, riboflavin, vitamin B6 and B12, niacin and folate in green
When little water is used for cooking green veggies, retain most of the minerals and vitamins.
Root veggies retain minerals and vitamins regardless of the amount of water used.
Let’s talk about trans fats or hydrogenated fats
The term “hydrogenated,” as in hydrogenated vegetable oil, means hydrogen is added to the oil. This process turns a liquid fat such as vegetable oil into a more shelf-stable, solid, and spreadable fat, such as margarine. Some oils are only partially hydrogenated, and in this process some monounsaturated fatty acids arev converted to saturated fatty acids (trans fats) that are harmful and can raise
cholesterol and increase the risk of heart disease.
It is best for health reasons to avoid eating frozen food in the supermarket, as you
know trans-fat is used to increase their shelf life and prevent going rancid.
They raise your bad cholesterol and lower your good cholesterol.
Eating trans fats increases your risk of developing heart disease and stroke. It’s also
associated with a higher risk of developing type 2 diabetes.
Remember what your grandmother told you.
Always cook your food in little water like curries and add a few tablespoons of
coconut milk for flavour or steam your veggies.
Restrict using oils for deep and stir frying as both results in high dense high calorie
flavoured foods that stimulates to eat more and result in inflammatory diseases like
coronary heart disease, stroke, obesity, diabetes and so on.
Hope you enjoyed this you tube and thanks for watching

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Hopper Nite

Hopper Nite

WE are in Sri Lanka now, in the ‘city of Kings’ (Kandy) holidaying and meeting friends for the next few months. This is an annual trip we make to avoid the winters in Sydney from May to October.We arrived a few days back without any hassles.We came across an army check point on Kandy Colombo Road: they were courteous and quite friendly. You need to show your passport. There is some inconvenience at Katunayake Airport. You need to walk with your baggage, of course helped by a porter to the car park, 200 yards away.
Our destination was Kandy and driving in the night takes two and a half hours. For the tourists the interesting places in Kandy are:
• Temple of the Sacred Tooth Relic.
• Kandy Lake.
• Giragama Tea Plantation.
• Peradeniya Royal Botanical Garden.
• Bahiravokanda Vihara Buddha Statue.
• Dalada Maligawa Museum.
• Esala Perahara.
• Walk in Udawattakele Forest Reserve.
• National Museum
People in Kandy, including the Kandyan’s are very friendly, and the only city where people still smile even to a stranger as a mark of friendship and welcome. Go for walk round the lake -4 kilometres, as most locals, do. You will enjoy this
walk on the lake bund.

What thins you could do in the night-time:

• 1/ Visit the Tea Factories.
• 2/ Traditional Kandy Dancing.
• 3/ Walk the Lake.
• 4/ Fill your belly at some of these restaurants.
• 5/ See the Temple of the Tooth.
• 6/ Discover Kandy from above at the Big Buddha.
• 7/ Take a stroll through the Botanical Gardens.
• 8/ Learn about Spices in the Spice Garden.

All hotel rates re very cheap now, and this would be the best time to plan a holiday venture in the Pearl of the Indian Ocean
Written by Dr harold Gunatillake
Can reach on mobile 0778611555

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