Dr harold Gunatillake

About Bread you purchase – Good advice from Dr Harold


The brown bread you buy from the bakery or supermarket may not be whole meal. Molasses or other things can give bread a brown colour. Always read the ingredient list.

The word “whole” should always appear before the name of the grain, such as whole wheat, whole oats, or whole rye. And it should be the first thing on the ingredient list.

Don’t be misled by labels that say “multi-grain,” “stone-ground,” “100% wheat,” “cracked wheat,” or “seven-grain.” These usually aren’t whole grain.

Warning: Putting bread in the fridge will make it go stale quicker.

Storage: Bread from the grocery store will stay fresh for 2 to 4 days if you leave it on the counter. Bakery bread, which usually has fewer preservatives, will keep 1 to 3 days.
If you want to store bread for a longer, put it in the freezer. It will stay fresh for 2 to 3 months.
Loading lot of salt: If you eat toast in the morning, a sandwich at lunch, and a roll with dinner, you’re not just loading up on carbohydrates. You’re also eating a lot of salt.
Most people get too much salt. When it comes to food sources, bread and rolls are the No. 1 source, beating out chips and other junk food.
A single slice of bread isn’t high in salt. A slice of wheat bread has about 147mg sodium. Eating bread several times a day adds up. Too much salt raises blood pressure. It can put you at risk of heart attack or stroke.

Enriched bread: The word “enriched’ appears on white bread and other bread products made from refined grains. Refining helps make bread light and airy and gives it a longer shelf life.
But it also strips away fibre, iron, and many B vitamins. “Enriched” just means that B vitamins and iron are added back after refining. But fibre may not be added back to “enriched” breads. Fibre is found in bread made with whole grains though, so that’s your healthier choice.

When you go to Sri Lanka, you’ll be eating white bread: whole meal bread is not popular and scarce.

New thought on white bread compared to wheat bread.

For some people study suggests that blood sugar levels did not rise- a process called the glycaemic response) with white bread or leavened wheat bread. The researchers found that there were individual variations and the blood sugar level did not rise comparable to the wheat whole meal bread. What it means is that the glycaemic responses, different people respond differently to the same kind of bread “In a broader sense, what this means is that the ‘one-size-fits-all’ diets that are given to the population as a whole, without personalization, are probably not optimal for everyone,” added study co-author Dr Eran Elinav, who’s also from the Weitzman Institute.

At the same time epidemiological studies has shown that people eating whole grain breads have reduced risk of type 2 diabetes, heat disease, inflammation, obesity and certain cancers.

Some believe that wholemeal bread contains less calories than white bread. However, they contain the same number of calories. What makes brown or whole meal bread better than white is the fibre, vitamins, minerals and phytonutrients found in the outer layer of the grain.

Fibber in wholemeal bread maintains a healthy stable blood sugar level leading to a feeling of satiety, due to slower digestion and absorption. Toasting bread removes the water from the bread and does not affect the micronutrients.

Over toasting and blackening of bread can lead to certain chemicals formation that can cause cancer.

Overall, it is advisable to stick to whole meal bread, though the taste is lesser, and the cost is more.

(Some reference to WebMD article)

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Are you dehydrated? – Good advice by Dr Harold

Do you know that most Sri Lankans in Sri Lanka are dehydrated without their being aware?

Being in a tropical country with frequent exposure to the hot sun with no head protection inevitably leads to dehydration. People stand in a bus queue for hours in the hot sun, but you don’t see them carrying water in a container to quench their thirst as required.

There was a time the younger generation in Sri Lanka did carry a bottle of water with them, but now that culture has disappeared, replacing with a smartphone.
What is dehydration? It means that you are not taking adequate quantity of water to replenish the daily requirement, and the body finds it difficult to keep your body temperature steady and clear your waste products through your kidneys and your skin. You are losing water all the time through sweat, tears, breathing and urination. At times of fever, and gastro-intestinal upsets you may lose addition water through vomiting and diarrhoea.

More than on an average 60 percent of your body is composed of water and the percentage of water in infants is much higher. With mild dehydration you could feel tired, may not excrete sufficient water in your pee, and your pee may be darker: may feel dry in the throat and even get a headache. You may not be aware that these symptoms are due to dehydration and may attribute to general tiredness from work.

Children get dehydrated much quicker than adults. If your child starts vomiting or having lose motions due to a stomach upset, start commencing giving water ad lib, to prevent dehydration. Soft drinks containing sugar are contraindicated as such drinks may extract more water from your body and pass out in your stools.
Babies may not be able to tell you when dehydrated. Look for a dry tongue and diapers may not be wet. With severe dehydration the eyes and cheeks may look sunken. They may breathe fast and have a rapid thin pulse.

Those who like treading in the jungle, taking adequate water with them are most essential, much more important than even carrying food. If you are adequately hydrated you could survive a good ten days without food, in such situations.

How much water should you drink per day? There are various theories on the quantity of water, and at what times of the day you should drink and so on. Believe whatever you want to believe, but whenever your urine is dark in colour and seems not passing out adequately please drink a few glasses of water immediately. If you are active you need to drink more, as after workouts in the gym.

One warning about drinking too much of water per day, is that your electrolytes such as sodium potassium and calcium may get diluted and may have bad effects on your nerves and bones. The kidneys may not be able to excrete the fluids efficiently. When your sodium gets diluted in your tissues and blood – the condition is referred to as, ‘hyponatremia’ It is advised not to drink energy sports drinks. They are meant for high-level athletes like the marathon runners.
If you are on a diet to reduce weight, drink adequate amount of water before a meal. That would give you a feeling of fullness and also dilute your acid juice reducing your appetite.

If you have persisted diarrhoea for over 24 hours, and can’t keep fluids in, you must visit the local hospital for intravenous glucose/saline drips.
It is a good habit drinking water from a wide mouth bottle, available in the super-markets for that purpose. Most of them hold 800 mls. of water. Add a few drops of organic apple cider vinegar into the water, keep it in the fridge and drink whenever you have the time. It is easy to drink a good half a bottle effortlessly, than sipping water from a tumbler.

When you go for your blood tests to the pathology centres drink adequate amount of water on empty stomach to hydrate your circulation. Drinking beverages like tea and coffee may dehydrate you due to their ‘diuretic effects’.

If you suffer from chronic constipation, please drink plenty of water.

Conclusions: If you feel tired and lifeless drink plenty of water and that would reward you with a better performance at work and make your day brighter.

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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I was asked, “What is the difference between vitamin D2 and D3?” – Good advice from Dr. Harold

image source: hyat

Vitamin D3 is produced in your skin from cholesterol (7-dehydrocholesterol) triggered due to exposure to the UVB radiation from the sun. But unfortunately, Sri Lankans even in Sri Lanka may not get sufficient vitamin D3, being a tropical country with full day sunshine, because they are indoors at home and at workplace, travel in air-conditioned vehicles, and always attempts to avoid the direct sun. Traditionally, Sri Lankans don’t seem to wear hats.
You need at least half hour exposure to direct UVB rays of the sun for pigmented people and twenty minutes exposure for light skin individuals. Light skin people could get sunburnt if over-exposed and becomes a major risk factor for skin cancer.

The alternative is to take vitamin D capsules as a supplement.

This ‘sunshine’ vitamin comes in two forms:
Vitamin D2 (ergocalciferol) and Vitamin D3 (cholecalciferol)

Now, you want to know the difference?
Both are fat soluble and needs to take foods with fats.
Vitamin D3 comes from animals and D2 from plants.
Animal sources are oily fish, liver, egg yolk, butter and dietary supplements.
Vitamin D2 is found in plant sources, like mushroom, fortified foods and dietary supplements.
Both D2 and D3 supplements and foods are absorbed into the bloodstream through your gut quite efficiently. The liver seems to metabolise the two differently.

Bit technical now: Vitamin D2 is broken down into 25-hydroxyvitamin D2, and vitamin D3 into 25-hydroxyvitamin D3. They are collectively referred to as calcifediol.

It is calcifediol that circulates in your blood, and on routine blood test for vitamin D level, it is the cacifediol level that is estimated.
It is observed that Vitamin D2 seems to produce less calcifediol, and vitamin D3 seems to raise the level more.
So, when you buy vitamin D from your pharmacist check that you are buying D3 and not D2.
You need to check your blood vitamin D level annually. Deficiency can cause problems without your knowing.
Vitamin D also functions as a steroid hormone which helps you to avoid erectile deficiency for men. This vitamin as a steroid hormone gets into the nuclei of every cell in your body to activate gene function, or switch off.

It is also revealed that deficiency can activate cancer development at cellular level.

It is observed that deficiency in vitamin D can lead to increased risk factor for heart disease
Children need to be fed with adequate amounts of vitamin D to avoid Type 1 Diabetes. Type 1 diabetes is caused due to your body immune system destroying the cells in the pancreas that produces insulin. Children should be given 2,000 IU per day to lower the risk of developing type 1 diabetes.
Adults also need to take vitamin D supplements to avoid developing diabetes.

Adults need to take these supplements to avoid falls and fractures of bones among the elderly. They should take at least 800 IU per day.
Children and adults suffering from asthma and frequent attacks of flu need to take vitamin D daily. It is shown that taking vitamin D supplements reduces the risk of respiratory infections and other diseases affecting the bronchial tubes and lung tissue.

Taking vitamin D supplements also extends your life span and reduces total mortality by over 6 percent.
Conclusions: Get your vitamin D level in your blood checked annually and take remedial measures, if required.
Hope this article is useful.
(Some reference to the article on Healthline)

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Have you checked your Blood Pressure recently? – Good advice by Dr. Harold

You get high blood pressure as you get older. Being a slow process of increase, you may not have any prodromal signs, until one day you feel dizzy. Blood pressure is cause by pushing the blood from the left lower chamber of your heart against the walls of the arteries that develops a resistance due to thickening (arteriosclerosis). As you know, your doctor will give you two readings when he checks your BP: upper pressure represents the pressure caused by the contraction of the left lower chamber of the heart (ejection pressure), and the lower reading represents the diastolic pressure due to the pressure in the arteries as the heart dilates.

In healthy active situation the best readings of your BP should be-systolic 120mm and your diastolic below 80 mm. High blood pressure (hypertension) is now defined as systolic pressure more than 130mm. and your diastolic pressure is more than 80mm. When your BP is over 180/120 you might go into a crisis and end up in the ICU.

If your home reading is over 140/80 you need to see your doctor soon to take measures to bring down the values to normal range.

The danger of having a sustained high systolic pressure is that the situation strains the heart due to the increased systolic pressure and may lead to heart muscle thickening (hypertrophy) and if neglected leading to heart failure which may be irreversible.

Further, symptoms with neglected high BP could be severe headaches, fatigue and tiredness at rest, vision blurring, chest pain, breathing problems, irregular pulse rates, blood in the urine, and pounding in the chest (palpitations), neck and ears.

Remember with continued high BP, you damage your arterial walls, risk heart disease, chronic kidney disease and may get a stroke.
If you are a diabetic, your chances of getting high blood pressure are high and you need to check your BP more frequently.
There are factors that can increase your BP, and you should attempt to eradicate them:

Smoking, Over-weight and obesity, lack of physical exercise, too much salt with your food, over-indulgence in alcohol consumption, aging, family history and genetics, stress at work, chronic kidney disease, and sleep apnea.

Conclusions: Please check your BP at least once in six months. Eradicate all risk factors. Your doctor will give you medication for hypertension, if it cannot be brought down by correcting the factors that’s causing it.

There are three kinds of medication you may get with persistent high BP. (1) Release the pressure on the heart muscle by giving calcium channel blockers to slow the heart. (2) Dilate the peripheral arteries by giving dilators. (3) control rapid heart rate by giving beta-blockers.
For older people, your doctor will prescribe medication to counteract the pressure caused by a hormone secreted in the kidneys called ‘angiotensin’. Angiotensin causes contraction of blood vessels, a natural mechanism in the body to compensate blood loss resulting in low BP (hypotension). These drugs are called ACE inhibitors, (angiotensin converting enzymes), and ARB drugs (angiotensin receptor blockers). Your doctor may prescribe a diuretic to pass more urine.

This is a brief account to make you understand the significance of untreated hypertension and the classification of medications you will be prescribed for hypertension.

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Recurrent nonspecific backaches – Good advice from Dr. harold

This applies to situations, quit commonly found among active people, getting neck aches and lower backaches with no specific condition affecting the spine, confirmed by CT scans and other tests.

These aches are due to muscle sprains and ligament strains found on either side of the spine, and most days you experience a sudden crooked spine with aches on one side of your back. You could use the term ‘Lumbago’ for this condition.

Simplest remedy is when you have your morning shower, make the water as hot and comfortable as possible. Whilst the hot water is hitting your back, bend down slowly and touch your toes a few times. Then, do a side bend to the right and then to the left. Do other movements to improve the mobility of the spine, a few times.

This alone may temporise your back problem for the rest of your day.

Sitting with your neck bent forward, or hunched as we call it, facing your computer can give you a neck-ache. This posture tends to flatten the natural curve of your spine and damage the cushioning discs between vertebrae and cause early arthritis.

Keep your PC screen at eye level; straighten your back whilst being seated. Gently stretch and move your head a few times to prevent strains, at regular intervals. Some blame the mattress for a crooked spine. The ideal mattress should be firm, and if the springs of your bed are worn out, sleeping on the mattress on the floor would be the answer.

If you are a back sleeper inserting a rolled towel under your knees will keep the natural curve of your back, and this may prevent the back ache.
Best position to sleep.

Do not sleep on your belly if you have a back problem. In any case it would bring back the ache if you sleep in this position.
Side sleeping would be the best position to sleep if you have a backache. Placing a pillow between your thighs would release the pressure on your hips and also relax your spine.

Exercising is very important whilst you have a backache. I find going on a treadmill at slow speed gives instant relief. Other low impact exercises like walking, biking and swimming strengthen your stomach and spine muscles which protect your discs in your spine.

You will notice that when get up from the seated position after sitting for a long time may experience backache. Just a bit of walking gives instant relief.
If you suffer from this malady, do not overeat and put on pounds. Extra pounds strain your bones and muscles of your back. Protruding belly due to overeating can hurt the lumbar spine very badly.

Those who use backpacks should not overload them. Your child’s backpack should not weigh more than 20% of their body weight.

Ladies wearing very high heels can strain their calf muscles, Achilles tendons and indirectly their lower spine. On returning home after work and removing high heels and getting into slippers may exacerbate the aches.

Doing slow yoga movements can help relieve low back pain. Over-doing it may hurt your back muscles.

Local spraying of anti-inflammatory sprays like voltaren seems to give temporary relief.

Certain spinal exercises done daily after a hot shower would be another way of getting relief. Any physiotherapist will demonstrate those exercises.

The author experiences lot of back pain after sitting in front of the computer long hours, and that has inspired him to write this brief article.

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