Dr harold Gunatillake

Good advice by Dr. Harold-Why do most people neglect to check their blood pressure regularly?

Strokes, cardiovascular events, peripheral vascular disease among others, are quite prevalent among our people, as they age.

One question to be asked is,” Do you check your blood pressure regularly?” and the answer would be in the negative, in most cases.

Preventable diseases lead to death due to ignorance and being not health conscious.

Investing in a digital blood pressure monitor should be the responsibility of every household.

Most people would say there were no symptoms to see the doctor. That is quite right, because high blood pressure does not occur overnight to give symptoms. The onset is insidious, and the body gets used to the higher pressures until one day a shocking complication occurs, as described above.

High blood pressure is called the silent killer, because, as mentioned, gives no warning signs or symptoms until a stroke or heart attack occurs. I have repeated this to emphasise the importance of knowing what blood pressure is and take precautionary measures to prevent illnesses, caused from hypertension: the simplest action would be to check your BP regularly with your own monitor in home surroundings.

How does one get high blood pressure? When you are young, your peripheral arteries are tender and elastic and not resilient to the pressure from the contractions of the heart (left ventricle). Their inner lining is smooth so the blood flows with no friction.

As one gets older the peripheral arteries become thickened and we name that condition, “arteriosclerosis”. In addition, plaques tend to build up in most vessels atjunctions, bifurcations and curves where the pressure of the blood turbulence is maximum. This condition we call, “atherosclerosis”, or simply plaques.

Both these conditions develop as one gets older, and the blood vessels become more resilient to the pressure from the contractions of the heart.  More forceful contractions of the left ventricle will result to distribute the oxygenated blood to the periphery. These resulting forceful contractions cause the high blood pressure.

Increased persistent blood pressure can cause aneurysms- a bulge at some weak point of the arteries. They can rupture and cause life-threatening internal bleeding.

One could easily assess the thickness of coronary arteries due to high blood pressure and other causes, by palpating the radial artery at the wrist joint. When you roll two fingers over your radial artery you could feel whether the artery is soft, more elastic, or thickened and feels firm. The latter findings reflect the situation of the coronary arteries, indirectly.

Taking fish oil capsules daily seem to keep your peripheral vessels more elastic. Lifestyle changes, such as less alcohol consumption, eating a low fat and low carb diets, regular exercise, meditation and less stressful life all contribute to keeping your blood vessels more elastic.

Medications could cause high blood pressure

Certain medications can cause high blood pressure. For instance, certain pain and anti-inflammatory medications can cause retention of water, resulting in kidney problems and increasing your blood pressure. Examples are non-steroid anti-inflammatory drugs (NSAIDs),

Certain antidepressants may cause your blood pressure to raise. These antidepressants work by changing your body’s response to brain chemicals, including serotonin, norepinephrine, dopamine and others. The chemicals in these drugs can increase your blood pressure.

Birth control pills and other hormonal birth control devices containing hormones may increase your blood pressure by narrowing smaller blood vessels.

Those who drink coffee, many cups a day can increase their blood pressure caused from caffeine. 200 to 300 milligrams of caffeine can temporarily raise your blood pressure.Medicine taken for colds such as decongestants seems to narrow your blood vessels, increasing your blood pressure. Good examples are Sudafed and neo-synephrine.

Be aware that most herbal supplements can increase your blood pressure. Good examples are Arnica, bitter orange, gingko, ginseng, liquorice, Senna, St. John’s wort and so on.

Certain immunosuppressants can raise your blood pressure, possibly because of the ways immunosuppressants affecting your kidneys.

Taking long term cortisone tablets orally, like prednisone can increase your blood pressure due to water retention.

There are in total about 22 medications that can give you high blood pressure. If you are on any of the above and other medications (not mentioned), it is advisable to record your blood pressure, weekly. Any changes, please contact your doctor.

Uncontrolled high blood pressure can weaken your blood vessels of the brain. Then, they can get narrowed, or rupture with a slow leak. High blood pressure can cause blood clots in the arteries and lead to a stroke, and dementia.

With uncontrolled high blood pressure, your left ventricle muscles of your heart can increase in size (hypertrophy), leading to an enlarged heart seen on plain x-rays of the chest (cardiomegaly).

With further uncontrolled blood pressure, the strain causes your hypertrophied heart muscles to weaken and work less efficiently. Eventually, the muscles weaken and leads to irreversible heart failure.

Just by checking your blood pressure regularly you could avoid life threatening heart failure.

Damage to the brain caused by high blood pressure

Atherosclerosis, a condition that thickens your blood vessels, as described earlier can cause a mini-stroke called Transient ischaemic attack (TIA). It is caused by the release of a blood clot from an atheromatous plaque in the inner lining of the carotid arteries in the neck. TIA is a warning that you are at risk of a full- blown stroke.

The symptoms of TIA are the same with a full-blown stroke, but it can be reversed by prompt medication. You need to be admitted to your local hospital without delay and the clots in the brain can be dissolved with blood thinners (heparin).


This is the most frequent illness caused by neglecting to check your blood pressure regularly. It occurs when part of your brain is deprived of oxygen and nutrients, causing brain cells to die.


In this situation one finds it difficult to think, speak, reasoning, memory loss, vision problems and unstable movements. This occurs due to narrowing and blockage of arteries due to uncontrolled high blood pressure.


Doctors classify high blood pressure as primary (essential) and secondary causes due to other pathological situations. What has been discussed so far is the primary situations where underlying causes cannot be found, other than the factors mentioned earlier.

Among the causes of secondary high blood pressure, kidney disease ranks highest. It can be triggered by tumours of the adrenal glands (glands sitting on each kidney like caps). These tumours secrete hormones that elevates the blood pressure.

Renal artery stenosis

When doctors cannot find a cause for the underlying high blood pressure, narrowing of the renal arteries needs to be ruled out. Stenosis is the word we use for narrowing of blood vessels, and the commonest cause is atherosclerosis, a process in which plaques made up of cholesterol and other material builds up on the inner lining of the blood vessels. If you suffer from primary hypertension, your doctor should investigate and rule out renal artery stenosis.

Abdominal scan studies are done to rule out renal artery stenosis.

Normal blood pressure

If you are diagnosed having high blood pressure you need to bring down the pressures to normal range – less than 120 (systolic) and 80 (diastolic).

In stage 1 hypertension the BP may be 130-139 (systolic) and 80-89 (diastolic)

In stage 2 the systolic is above 140 and diastolic above 90.

In a crisis your systolic pressure could be over 180 and diastolic higher than 120.

If you are diagnosed that you have high blood pressure, it would be your responsibility to take measures to reduce it.

Remedial actions

Walk regularly- Do 20,000 steps a day.

Reduce your sodium intake. Eating tasty restaurant foods are full of salt. Avoid them as much as possible until your p is controlled.

Drink less alcohol

Eat foods containing potassium

Reduce your coffee drinks

Learn to manage your stress

Lose weight

Eat veggies that brings down your BP, such as beetroot, and a variety of other foods and fruits.

Bottom line

Controlling your blood pressure is simple.  Purchase your own BP monitor and check your BP regularly.

Checking your BP regularly can avoid other chronic illness mentioned before.

The author’s personal experience is that walking 30,000 steps at intervals daily, would dilate your blood vessels to reduce your high blood pressure, without medication. Further, that would be the quickest way to get rid of your accumulated ‘triglyceride’ stores in your fat cells to reduce weight. The best way to wash off your unhealthy visceral fat that cause heart disease, would be that way.

Hope this article was of value from a health-point.

About the author: 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








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Good advice by Dr Harold – Is Fish Oil another Snake Oil?

Talk of the town was coconuts sometime back, how bad it was for the humans, and one lady professor claimed it was poison. Now the focus is on fish oil that has been popular and believed to lower the risk of inflammatory diseases, heart disease, stroke, and improve the intelligence of kids, among others.

A recent study on 15,000 people in the UK published in the New England Journal of Medicine, revealed that participants taking a daily capsule of omega-3 fish oil did suffer from heart attack and stroke as much as people not taking any fish oil. The study revealed that 8.9 per cent of the people given the fish oil capsules suffered a heart attack or stroke, compared to 9.2 percent in a placebo group, and the difference is marginal.

This study was done on diabetics, and not on others. The question is will omega-3 fish oil capsules do help to prevent heart disease and stroke among the non-diabetics? 

Another series of studies done by the South Australian researchers at the Medical Research Institute in Adelaide found that fish oil doesn’t make more intelligent and smarter babies.

A group of women were given a daily dose of 800mg of docosahexaenoic acid (DHA), an omega-3 fatty acid found in fatty fish during the second half of their pregnancies. A second group of pregnant women were given a placebo.

 The fish-oil kids – at 18 months old- showed no superior or accelerated cognitive, language, and motor development than the babies whose mothers took a placebo.

But, this does not prove that fish oil given to mothers are not doing some good to the foetus.

The beneficial factor in fish oil is eicosapentaenoic acid (EPA) and docosahexaenoic acid
(DHA). These two fatty acids have been considered so far to boost optimum brain function and regulating the serotonin levels in the brain. DHA is highly concentrated in the brain, retina, testicles and semen.

People often lack enough omega-3 fats (polyunsaturated), mainly DHA (antiinflammatory)
which is necessary to balance with the inflammatory omega-6 fat ratio. The ratio is considered 1:1.

What this implies is that taking more inflammatory polysaturated fatty acids as cooking oils, or in food may lead to inflammatory diseases. So, you need to increase your omega-3 fatty acids to neutralize the bad effects of the inflammatory omega-6 fatty acids.

Omega -3 fatty acids are found in vegetables, too. It is an essential fat that our body cannot make. These anti-inflammatory foods can repair damaged cells and restore a healthy balance that can prevent diseases like Alzheimer’s, cancer, heart disease and arthritis. In one study, men took fish oil capsules containing DHA supplements for 12 weeks decreased the concentrations of several inflammatory markers in their blood by about 20%.

These omega-3 fatty acids can be obtained from fatty fish, especially tuna, salmon, mackerel. Vegetables containing omega-3 fat are flaxseeds, walnuts, chia seeds, canola oil,

In another study it was found that fish oil higher in EPA than DHA lowered inflammatory cytokines, associated with neurodegenerative and autoimmune diseases.

Studies also showed that a dietary supplementation of fish oil lowers the activity of chronic inflammatory diseases like rheumatoid arthritis, Crohn’s disease, ulcerative colitis, psoriasis, lupus erythematosus, multiple sclerosis and migraine headaches.

It is observed that arthritic patients benefit and respond well on taking 10 capsules of fish oil a day.

The National Heart Foundation in Australia advises some people with high risk factor for heart attack or existing heart disease to take omega-3 supplements.

Despite the above two studies mentioned- population studies have consistently found that omega-3 fatty acids cut down the risk of heart disease by 18 per cent.

Why then eat fish?

Fish is recommended twice a week for people, because of its health benefits of the omega-3 fatty acids in the body of oily fish, which includes eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA). These fatty acids being anti-inflammatory in action prevents chronic inflammatory diseases as mentioned earlier, including heart disease.

The rate of coronary heart disease among Japanese men is less than on third that of the U.S. at 45.8 (per 100,000/year). While American men have a rate of 150.7, though the percentage of men who smoke is 35.4%, more than double the rate of 17.2% in the U.S.

Japanese eat a lot more fish than Americans, and this is important, since omega-3 fatty acids, the type in which fish is abundant, are protective against heart disease

A study done in 2005 found that the more fish the Japanese ate, the higher was their consumption of omega-3 fats, and the lower was their rate of heart disease

Bottomline: Do not get discouraged by the two studies showing that fish oil does not benefit to reduce the risk of heart disease, stroke, and not help in enhancing the I.Q. of  kids.

Population studies and epidemiological observations prove otherwise.

Hope this article will convince you to continue taking fish oil supplements

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Desmond rocked Kandy – Reported by Dr Harold Gunatillake
Desmond desilva

“The great entertainer of all times” performed at the Royal Crown hotel, Ampitiya Kandy, Sri Lanka, on the 2nd September for a crowd of over 1000 young and old merry-makers.

Youthful golden voice has not changed after decades of performing and considered as the “King of Baila”.

The hall was packed with young and old revelers, and there was hardly any space on the dance floor left when Desmond started his renditioned accomplished English and Sinhalese old songs of his top hits followed by his favourite Baila sessions which continued till on midnight.

Kandy mayor Kesara Senanayake was one of the chief guests.

It was a very memorable event for the revelers, and more the hotel service was par excellence.

Desmond desilva


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