What does extra salt do to your body- the planet’s tastiest mineral?-By Dr Harold Gunatillake

Harold Gunatillake


Transcript: During the migration in evolution from the sea to the land, we brought sea salt with us in our evolutionary phase.
Human body contains many salts of which sodium chloride or table salt is the major one, making around 0.4 per cent of the body’s weight a concentration pretty well equivalent to that in seawater.
So, a 50kg person would contain around 200g of sodium chloride, and that is 40 teaspoons.
Sodium is a mineral your body cells need to work normally. It helps efficient function of nerves and muscles.
Salt is essential to health. We can’t survive without it.Your body can’t make it, and your cells needs it for proper function, help muscles and nerve function and keep the body cells hydrated.
New dietary guidelines came out with an upper limit of the recommendations is to consume 2300mg of sodium daily equivalent to one teaspoon. Our body needs only 500mg to carry out body functions like muscle contractions and nerve transmissions.
We lose sodium through sweat and urine. If this is not replenished you might feel light headed and dizzy.
It also helps to keep the right balance of fluids in your body, with the help of proper functioning kidneys.
If you suffer from chronic kidney failure, or end-stage renal disease it will be hard for your body to balance your fluid volume with the right amount of sodium and keep the right balance.
With kidney disease, your kidneys struggle to filter out the extra sodium, causing your blood pressure to go up.
High blood pressure can damage your blood vessels, heart and brain.

Read More →

High Blood Pressure and Stroke-by Dr Harold Gunatillake

Harold Gunatillake



Yes, most strokes are preventable.

Unchecked high blood pressure is the most common and important known risk factor for stroke, heart attacks and kidney failure, loss of eyesight and even Alzheimer’s disease.

You can effectively and successfully lower your blood pressure and prevent the above episodes by checking your blood pressure at home.

Increase blood pressure due to extra forceful pumping of the heart, really the left ventricle, cause intense pressure on the walls of your arteries. This high blood pressure causes damage or injury to the inner lining of the arteries, which progresses to a condition called atherosclerotic plaques.

Read More →

What are Angiotensin inhibitors and Angiotensin 11 receptor Blockers?-By Dr Harold Gunatillake

Harold Gunatillake


When you are over 60, high blood pressure also called Essential hypertension is most likely to occur in men and women equally. There is no identifiable cause, but is thought to be linked to genetics, poor diet, lack of exercise obesity and stress factors.

It is a silent killer, unless BP is checked regularly and treated with antihypertensive medication if the readings are above the normal range and lifestyle changes.

Other inevitable causes are insulin resistance, high alcohol intake, high salt intake, aging, low potassium, and calcium intake

Read More →

Health & Views – August 1st Issue – by Harold Gunatillake

Dr Harold

Download the PDF file .


The information contained in this article is for general information purposes only, and whilst the author will endeavour to keep the information up to date and correct, eLanka makes no representations or warranties of any kind, express or implied, about the completeness, accuracy, reliability, suitability or availability with respect to the eLanka website or the information, products, services, or related graphics contained in this article for any purpose. Any reliance you place on such information is therefore strictly at your own risk. In otherwords, eLanka In no event will we be liable for any loss or damage including without limitation, indirect or consequential loss or damage, or any loss or damage whatsoever arising from loss of data or profits arising out of, or in connection with, the use of this website / article. Also please note that through this website / web page articles you are able to link to other websites which are not under the control of eLanka and therefore we have no control over the nature, content and availability of those sites. The inclusion of any links does not necessarily imply a recommendation or endorse the views expressed within them

Read More →

Video talk on high blood pressure – BY Dr Harold Gunatillake

Dr Harold

Let us discuss today, the importance of checking your blood pressure regularly.When you are 40 and over, it is advised that you check your BP annually.Owning your own BP apparatus would be an impetus for such recordings, regularly When you are a kid, your heart works beautifully with absolute, no strain. This is attributed to the fact that all your arteries -major, minor and minute tributaries to the fingers and toes are expandable, elastic and mobile, and not stiff, causing no resistance to the pumping action of your heart.

With age, the blood vessels seem to harden, become less expandable, becomes stiff and increases the resistance on pumping the blood from your heart.With increased resistance from the thickened blood vessels the heart needs to pump more forcefully.

That creates the higher pressure on the arteries, and that would be the onset of high blood pressure.

This pressure is measured by the sphygmomanometer by your doctor in his office. The upper reading is referred to as the systolic pressure, because that is a measure of how much the left ventricle of your heart is straining to pump the blood to the periphery.

When the left ventricle of your heart which pumps the blood to the periphery now needs to relax to fill with blood from the left upper chamber -called the left atrium.The lower pressure created in the blood vessels is related to the phase when the heart muscle relaxes between beats allowing the chambers to fill with blood. This is referred to as the diastolic pressure

So systolic pressure is when the heart contracts, and diastolic pressure is when the heart relaxes to fill with blood for the next beat, or you could say between beats. Adults should keep their systolic pressure at 120mm. of mercury and the diastolic could vary between 60 to 80 mm. of mercury.

When the diastolic pressure is more than 90 or higher means you have high blood pressure.

There was a time when your doctor would say when the BP is higher, it is okay for your age.

Now, it is believed that all adults at any age should keep the BP consistently at 120/60-70

Both systolic and diastolic blood pressures are important, but for those forty and older systolic is more important than the diastolic. It is the systolic pressure what increases our risk of having a heart attack, stroke or artery disease in the legs. So, remember, that systolic BP is more important and needs to be kept at 120mm of mercury.
No bargaining at all.

When the BP increases with a systolic pressure of 180 mm of mercury or higher or a bottom number of 120mm Hg can damage blood vessels and is referred to as a hypertensive crisis.

In the early stages of rising blood pressure, it happens so slowly over months or years, the body seems to accommodate the increase until such time the vessels cannot tolerate anymore, and the warning signs are imminent.

This is the main reason why you should check your BP at home or with your doctor frequently with every visit to your doctor, to prevent such episodes that can cause instant death.

How can you prevent high blood pressure?
The answer applies to all chronic diseases whether it’s high blood pressure, heart disease, cancer, diabetes among others.

Eat the right foods meaning unprocessed low fat, and low carb in small quantities at a meal.

Avoid animal foods with high saturated fats.
Avoid those foods in the refrigerated section of your supermarket where all frozen foods are saturated with transfat- a killer that is used to maintain the shelf life of foods.

Exercise daily, at least a brisk walk of 10,000 steps.
Control your diabetes with medication and low GI foods.
Eat more oily fish than meat. Oily fish contains omega 3 fatty acids that keep your blood vessels soft and elastic.
Now let’s talk about the pulse rate or heart rate
When you get your BP checked you don’t seem to record the pulse rate which is as important, for deciding on medication for high BP.

If your BP is high and pulse rate is also rapid- more than 80 per minute at rest, your doctor will prescribe certain drugs like betablockers and calcium blocker drugs in addition to slow the heart rate to about 70 at rest.

When you exercise your target heart rate tells you if you’re exercising too hard or not hard enough. Everyone’s target is different, but in general, during moderate or vigorous exercise, you want it to be between 50% and 85% of your maximum heart rate, which is the hardest your heart can work safely. Your maximum heart rate when you exercise should be 220 minus your age.

Using a heart rate monitor can help you get fit.
Wearable electronic heart monitors, and exercise machines with built-in heart sensors, can give you up-to-the-minute information on how hard your heart is working. That can tell you how hard you’re exercising. It can help you pace yourself, too. It may even help keep you motivated.
Hypertension is the most common condition seen in old people and lead to heart attack, stroke, kidney disease, if not detected early and taken steps to treat adequately.
Blood pressure increase is inevitable as you age, due to the thickening of arteries- a natural event called arteriosclerosis.
The heart becomes strained to push the blood from its left ventricle into the circulatory system.
High blood pressure is avoidable if you take steps to check your BP regularly.
Hope this video has been useful.
Thank you for watching

Read More →

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








Read More →

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.

Read More →