Dr harold Gunatillake

Measuring your waist-line reflects your state of health and risks – Good advice by Dr. Harold Gunatillake

“Our people would live longer, being healthier, solving hospitals overcrowding, reducing morbidity and mortality stats. by just measuring your waistline and taking remedial measures, if required”

It is a shocking observation that most adult people are ‘pot-bellied’ in Sri Lanka, especially those who lead an affluent lifestyle.

Contract workers, those wearing helmets seen sweating on top of new building constructions in the urban cities, poorer strata of people and farmers in the rural areas toiling in their rice fields seems to escape this phenomenon.

The reason is obvious, the hard-working outdoor people are the poorer lot, and thrive on meagre salaries, unable to enjoy calorie dense foods the richer enjoys, moving about in vehicles. Stand in front of a five-star hotel one evening, you see the lucky affluent men, including their family members getting out from their luxury vehicles, whizzing eagerly for a delightful evening meal. Most of these adult people including their kids are over-weight with pot bellies.

There is no media recognition of this situation and advising people to take remedial measures to stay within the normal BMI range, instead more exposure to TV channels focusing on weeping sad soap operas during prime time.

Occasionally, good health programs do appear on tele, but unfortunately, the medical personnel who discusses health issues use a language that the average person does not understand: more suitable for a medical audience.

Most people tend to eat processed foods because they are cheaper and tastier on the taste buds. Foods made of processed wheat flour and rice flour are being sold on the streets and in most food outlets. Indulging in this sort of foods is a risk factor for obesity.

Such facilities like the gyms and walking paths are available, and it’s the shapely young ones patronize those gyms for better looking bodies, and daily walks are mainly seen by those who have had heart episodes, or on doctor’s advice.

Most of these adult victims have had no time before the cardiac event to go for walks daily, because they don’t create the time for it. After the cardiac event they seems to find the time.

Importance of measuring your waistline

My advice is that all adults- men and women should measure their mid-waist-lines at some stage in their life. This is easy and is not about your clothing size.

You need to measure with a tape round the circumference of your belly at the belly button level (narrowest area of the trunk).

You need to stand up straight.

Make sure it’s not too tight or too lose when you take the measurement.

Don’t hold your breath and take the measurement after you exhale. Do not suck your abdominal wall muscles into your cavity.

Men should have a waist less than 40 inches around your waist line, and less than 35 inches for women.

If your measurements are above those, you are carrying excess weight around the middle, chances are you’re harbouring a potentially dangerous amount of visceral fat in your tummy and you should start on a health plan to reduce to the normal range

Having bulges on the sides of the abdomen (love handles), having fatty thighs and backs and upper arms are harmless, other than for cosmetic reasons. They are just under the skin fat (subcutaneous fat) and are quite innocuous

Having a pot belly above the healthy waistline measurements carries risks of certain chronic diseases that can shorten your life.

The pot belly is mainly due to the loads of visceral fat within your abdominal cavity. This visceral fat is dangerous, and you are exposed to heart disease, high blood pressure, diabetes, sleep apnoea, atherosclerosis (thickening of blood vessels with plaques), colo-rectal cancer, breast cancer, and linked to erectile dysfunction in men over 60 years of age.

Visceral fat is now considered to be an endocrine organ secreting hormones and other chemicals that carry the risk of chronic diseases, including coronary heart disease.

  • To lower your risk of the above diseases, start on a diet plan lower in kilojoules and saturated fat. Eat more proteins and fibre, reduce your starch and added sugar beverages and foods.
  • Do some daily exercise: walking 10,000 steps daily (takes one and a half hours) burns over 200 kilocalories. You may gradually increase your steps to 20,000. Wear a pedometer or a Fitbit watch to keep a record of your exercise level and as an impetus to do more.
  • If you are more enthusiastic do some aerobic exercises, bicycle rides. Bicycle crunching seems to help: crunching the stomach while extending your legs.
  • Daily swimming is another way of reducing your belly fat and toning your body.

It is so simple to assume that by measuring the abdominal girth as a routine by both men and women, taking remedial measures if excessive, may reduce the health costs and ease the burden on hospital beds in private and public hospitals, and further create a healthy nation. Health administrators in Sri Lanka needs to think on those lines and take remedial measures in public awareness and education through the mass media.

Bottom line

So, the above lifestyle changes will inevitably reduce your waist circumference and your risk of many chronic diseases, including diabetes type 2 enhancing insulin sensitivity. Even the incidence of bronchial asthma can be reduced by overweight sufferers by taking simple remedial measures.

Most of all you could prolong your longevity and prevent risk of premature death.

Please take my advice seriously and measure your abdominal girth, today and see your doctor if above the range of measurements mentioned before.

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Good advice by Dr. Harold – Vegans are disadvantaged – Vitamin A deficiency

Vitamin A is essential to promote your immune system, bone growth, health and well-being, maintain a moist skin, assist in growth and many other metabolic functions including night driving.

Deficiency of vitamin A can result in dry skin, dry eyes, infertility and trouble conceiving, delayed growth, frequent throat infections, poor wound healing and acne breakouts

Vegans should look out for these symptoms.

Animal foods and products, including eggs have vitamin A as ‘Retinol’. Retin A (retinoic acid) cream is derived from retinol used as a mild peeler on your face and promoted as an ‘anti-aging skin cream’.

Most plant foods do not seem to contain fat soluble vitamin A known as retinol, instead exists as a pre-cursor called beta-carotene mostly found in vegies.

Retinol (vitamin A) from animal foods are absorbed readily in the gut, but vitamin A derived from plant-based beta-carotene is more limited, meaning you lose Vitamin A in the process of converting beta-carotene to retinol.


The richest sources of beta-carotene are yellow, orange, and green leafy fruits and vegetables (such as carrots, spinach, lettuce, tomatoes, sweet potatoes, broccoli, cantaloupe, and winter squash). In general, the more intense the colour of the fruit or vegetable, the more beta-carotene it has.

In our intestines beta-carotene is converted into vitamin A by an enzyme.

Vegans may lack the enzymes that play an important role in helping to produce vitamin A from plant-based foods.

Furthermore, our genes (beta-carotene gene-BCO1) also play an important role in helping to produce the enzyme that converts beta-carotene into vitamin A.

Animal foods, by contrast supply vitamin A in the form of retinyl palmitate which is converted to retinol in the small gut, which doesn’t require any gut enzymes for the conversion.

The other source of vitamin A is from antioxidants known as ‘carotenoids’

Beta-carotene mentioned earlier as found in yams and carrots are derived from this antioxidant carotenoids

The bad news is that certain gene mutations can stop enzyme activity and prevent beta-carotene being converted to retinol. The enzyme that does this conversion is-15,15′-monoxygenase (BCMO1)—

There could be several gene mutations that can prevent conversion of beta-carotene to retinol. A host of non-genetic factors can lower beta-carotene conversion in the gut to retinols leading to vitamin A deficiency.

Further, the lack of this conversion can affect thyroid function, alcoholism, liver disease and zinc deficiency.
In the Western world, 70 percent of the vitamin A is provided from animal foods and only about 30 percent from carotenoids.

Foods that are particularly high in vitamin A include: carrots, sweet potatoes. winter squash. cantaloupe. apricots. spinach, kale, and collard greens.
Eating these veggies will prevent vitamin A deficiency among Vegans.

Vegans need to be aware of vitamin A deficiency and for peace of mind the blood levels should be checked by the pathology labs. Meanwhile those vegans who don’t lack the enzyme BCMO1 can produce enough vitamin A from plant foods to stay healthy.
Ref: Echo Watch article By Denise Minger

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Alcohol what it does when consumed


Few weeks back I wrote an article on the beneficial effect of alcohol to prevent dementia. Let us delve deeper into alcohol nutrition and discuss what happens to that glass of alcohol you enjoy, in your constitution.

It is a fact there is no social event without alcohol flowing. It relaxes the participants and brings mates together for a relaxed enjoyable evening with conversations, at a party or celebration.

When, even taking two small drinks a day has its added health benefits, but the negative consequences that it brings when taken in excess has problems to self and family.

Alcohol is not an essential food like the carbs, protein fat, vitamin, minerals and water you consume daily. Alcoholic drink primarily consists of water, alcohol and sugar. The calories come from alcohol and sugar are referred to as, ’empty calories’ because of the lack of any nutrients.

Though in most countries people drink alcoholic beverages, the percentage of addiction seems to be small, as most drink only on occasions. People below the poverty line seems to drink more than the affluent.

Alcohol is made through a process of fermentation when sugar breaks down into ethanol (alcohol) and carbon dioxide. At the next stage carbon dioxide gas bubbles escapes into the air, leaving alcohol and water. Then, through a distillation process water is separated from the alcohol.

When we talk of just one drink, we mean a 12-ounce glass of beer, a 5-ounce glass of wine, and a 1.5-ounce shot of liquor and all contain a half ounce of pure alcohol.

Metabolism of alcohol

Alcohol unlike carbs, protein and fat is not stored in the body. Hence the liver metabolises alcohol as a priority in preference to any food you consume.

20 per cent of the alcohol you consume is absorbed directly from your stomach into the blood stream and goes directly into your brain. The rest of the alcohol enters the small gut and is absorbed with the other food. Alcohol is then metabolised in the liver and is excreted through your sweat, saliva, urine and your breath.

Metabolism of alcohol solely occurs in the liver and those who indulge in excess cause liver problems. Alcoholic fatty liver is quite a good example, and with further daily indulgence makes the liver harder (cirrhosis) and lead to failure of functions.

Alcohol is made less toxic through a process of detoxification in the liver, is removed through a process called oxidation.

Excess alcohol damages your liver

One of the severe side effects of alcoholism is liver damage, may lead to death.

Alcohol is converted into acetaldehyde a toxic enzyme that can damage liver cells and cause fibrosis (scarring). It is also a carcinogen. Alcohol dehydrates the body and the liver requires water to function correctly. When the body lacks it, the liver requires to force to pull in water from other sources.

It is very important to hydrate yourself by drinking plenty of water or any sweet drinks after a heavy session of drinking alcohol.

Your liver can become fatty, or cause inflammation (alcoholic hepatitis) and end in cirrhosis with regular excessive drinking.

In a fatty liver there is infiltration or build up of fat in the liver cells when you drink too much of alcohol more than the liver can cope. Fat infiltration causes inflammation of the liver cells and results in alcoholic hepatitis.

Alcoholic hepatitis is caused by excessive drinking alcohol for a long time. Ultimately the liver cells are replaced by scar tissue (fibrosis) and the term cirrhosis is used.

When you are diagnosed with cirrhosis you need to stop alcohol totally and the liver cells may repair and attempt to function normally. If it is in the irreversible phase unfortunately stopping alcohol may not help.

Generally, it is important to eat a healthy diet to lead a healthier liver. Avoid eating processed foods, sugars and saturated fat to ease the burden on the liver.

Most people drink less as they grow older, as the hangovers they experience day after could be a misery. Some people tend to drink more as they get older due to loneliness, losing a loved one, reduced income and so on.

As you get older the ability of the liver to metabolise alcohol declines. Older people drinking the same amount of alcohol as younger people, the blood concentration of alcohol seems to remain longer among the old, as the elimination is slower.

Age related changes and alcohol

Age related changes like your eyesight, hearing and reflexes may get accelerated with chronic excessive alcohol consumption. These changes will make you feel dizzy, unsteady on your feet and alcohol related falls, automobile accidents and so on.

Your medication that you take for your age-related illnesses including heart disease, hypertension, diabetes, among others may have deleterious effects on your body. Please do not mix medication with alcohol. It is advisable not to drink alcoholic beverages when you are on any medication.


Those who drink excessively do not seem to eat nutritious food, because alcohol replaces foods. You may get ill-nourished or malnourished when the essential nutrients do not get into your body. It brings vitamin deficiencies like B1, folate, B12, A, and minerals like calcium.

Amino acid absorption

Proteins you eat in your food is broken down into amino acids and absorbed in the small gut. Alcohol can disturb the normal digestion of food and amino acids may not be absorbed from the proteins in your food.

In situation of a chronic failing liver this can lead to complications, like decreased albumin in your blood causing ascites (fluid in your abdominal cavity, swelling of legs called oedema.

Portal hypertension

Cirrhosis of the liver also causes obstruction to the flow of blood from the gut through the portal veins. The veins get distended and we call the condition as portal hypertension.

Veins in relation to the lower oesophagus and the stomach can get distended and varicosed. These delicate veins can rupture and cause vomiting of blood (haematemesis)

This is an irreversible stage of cirrhosis that causes the veins feeding the liver to distend and rupture.

Fluid collects in your abdominal cavity (ascites), and varicosed veins are seen on the abdominal wall. Legs start swelling and your life is in danger.

How much alcohol can you drink to avoid complications.

For healthy men up to age 60- no more than four drinks in a day and no more than 14 drinks a week.

For healthy women and healthy men over 60-no more than three drinks ina day or seven drinks in a week.

Asians being smaller made should restrict to two drinks a day.

New research, which was presented at the American Association for the Advancement of Science’s annual conference, has found that moderate drinking is linked to a longer life. Drinking about two glasses of wine or beer a day was linked to an 18% drop in a person’s risk of early death—an even stronger effect than the life-preserving practice of exercise, according to the researchers.

A 2015 study of people with mild Alzheimer’s, found that moderate drinkers were less likely to die during the study’s follow-up period than teetotalers. A large 2017 study also found that light and moderate drinkers were less likely to die from cardiovascular disease than those who never sipped. Red wine, in particular, is often singled out for its anti-aging benefits, usually because of a compound called resveratrol — though that explanation may be a little oversimplified, and more research is needed.

A large 2017 study looking at alcohol and heart health, however, was designed to eliminate the possibility of abstainer bias. It still found that moderate drinking may protect against heart attacks, strokes, chest pain and fatal heart disease. (ref: TIME HEALTH-by Jamie Ducharme).

New findings: No healthy level of alcohol consumption, says major study
Governments should consider advising people to abstain entirely, say authors. Article appears in The Guardian-written by Sarah Bosely.

The article states, “Even the occasional drink is harmful to health, according to the largest and most detailed research carried out on the effects of alcohol, which suggests governments should think of advising people to abstain completely.

The uncompromising message comes from the authors of the Global Burden of Diseases study, a rolling project based at the University of Washington, in Seattle, which produces the most comprehensive data on the causes of illness and death in the world.”

Conclusions: If you understand the word ‘moderation’ you are qualified to have a drink or two, daily. Abstaining would be better. Then, studies show that people who drink moderately live longer. Take your pick.
Ref: Alcohol and Nutrition by Betty Kovacs Harbolic

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