health wise

Age no bar for ‘mother of all illnesses’

by Harshini PERERA

A very large number of people, 246 million suffer from diabetes worldwide while 2.1 million are in Sri Lanka. 16% of the urban population and 8% in the rural areas suffer from diabetes. This ailment has no particular age category and juvenile diabetes has become very common in Sri Lanka.

Dr. Mahen Wijesuriya, President of National Diabetes Centre said that, “the diabetes Association of Sri Lanka is in the process of identifying those in the high risk category among the urban population of Colombo.

We have studied nearly 25,000 young persons below the age of 40, the youngest range between five to ten. Nearly 30% of those studied have shown an increase in diabetes due to causes like family history, obesity and increase in waist measurement and less exercise habits.”

Dr. Wijesuriya explained that the combination of wrong dietary habits, reduced exercises, increase in stress level are some of main causes of diabetes in any age group, especially in the young.

“We feel the rising pandemic can be halted. The rise is an enormous increase from 50 million persons in 1985 to 150 million in 1990 and 260 million in 2005. WHO has estimated that it would reach 388 million by the year 2025 and is among the largest in South East Asia. This clearly shows that diabetes is not a rich man’s illness any more.”

Dr. Wijesuriya explaining further said that this is so because, in poor Asian countries, the nutrition for a baby in a mother’s womb is compromised. Such babies are born small (less than 2.5 kg) due to abnormal nutrition and develop diabetes through insulin resistance.

The last causative factor, but not the least, is psycho-social stress due to failure of expectation in the achievement of education, jobs and economic upgrade. The failure to achieve success in one’s life is present from young age and seems to play a significant role in diabetes.

When he was asked for a way out he said, “We, as individuals or family should be moderate in our food in giving preference to high fibre, starch products, fruits and vegetables. Exercise is a must with walking, cycling, swimming and games where effort is important.

“We consider diabetes as the mother of all illness, for two major reasons. One, affects every cell of the body and the other, affects more people than any other diseases including AIDS.

The National Diabetes Centre bent on research

Prevention their main concern:

by Sajitha PREMATUNGE

The National Diabetes Centre is one and the only centre dedicated to education and care of patients. But since its inception in 1995 much has changed and in 2002 they have decided to add another dimension to the main objectives of the Centre - prevention of diabetes. Today this has become one of their primary goals.

“The number of diabetic patients are increasing exponentially that its prevention has become our main concern”, said Dr. Mahen Wijesuriya, President, National Diabetes Centre. They hope to educate the public through awareness programs.

The Diabetes Association of Sri Lanka is a member of the South East Asia Region of the International Diabetes Federation (IDF) - of which Dr. Wijesuriya is the Chairman for South East Asia Region - which has a membership of 170 Associations worldwide.

“The National Diabetes Centre was initiated with a grant from Sri Lanka-Canada Development Fund and built on UDA land”, said Dr. Wijesuriya. “And is sustained on the generous donations from the public.”

He further explained that the service of all members of the board of trustees, executive committee and board of management are voluntary.

According to Dr. Wijesuriya the Centre receives four types of patients - patients who come for screening for the first time, patients who come for reassessments, check-ups to exclude the possibility of diabetes or for eye or kidney complications.

The Centre operates on the belief that patients should be given priority and provides services free of charge when required.

In fact this is the only non-governmental facility that provides services free of charge, depending on the financial status of the patient.

Anyone could walk into this facility without any appointment or referral. The screening is carried out by a team of medical officers and a comprehensive report is issued. It is armed with state-of-the art equipment operated by skilled staff.

This facility is open to the general public as an independent service, where all the relevant biochemical estimations are performed.

Various offered by the Centre include cardiology clinic, vascular clinic, healthy life-style clinic, childhood obesity/young people’s diabetic clinic, insulin bank and other laboratory services. According to test results the Centre directs its patients to their various clinics for further treatment.

A single visit screening involves a complete physical and bio chemical screening to determine whether complications could arise due to Diabetes.

Their Neuropathy Clinic assesses the severity of nerve dysfunction, where specialised care is given to affected individuals; Nephropathy Clinic assesses kidney damage in diabetic patients and the affected individuals are provided with specialised care; Eye Clinic assesses the abnormalities of the eye and is done both by eye examination and retinal photography.

This system is a hi-tech computer imaging system that could document and archive for future reference. Dr. Wijesuriya explained that most of their projects are research oriented.

Their ongoing projects - apart for services mentioned above - include diabetes in pregnancy and a project to assist persons with diabetes affected by the tsunami disaster. But the most promising in terms of research possibilities, is probably their project on the risk of diabetes in the young.

Donations may be remitted to: Diabetes Association of Sri Lanka, 50, Sarana Mawatha, Rajagiriya.

Preventing heart attacks

How to increase your HDL (good) cholesterol level:

by Dr. D. P. ATUKORALE

It is common knowledge among medical personnel and some non-medical persons that there are two types of cholesterol namely (a) Low Density Lipoprotein (LDL) cholesterol or bad cholesterol and (b) High Density Lipoprotein (HDL) cholesterol or good cholesterol.

Persons with low HDL cholesterol (less than 40 mg per decilitre in men and 50 mg per decilitre in women) have increased risk of coronary heart diseases (heart attacks and angina), strokes, blockage of coronary artery grafts, blockage of coronary arteries after angioplasty (PTCA) and peripheral vascular diseases (intermittent claudication).

Often persons with low HDL cholesterol levels also have other coronary risk factors such as diabetes, hypertension, high serum triglyceride levels which further increase the risk of cardiovascular deaths.

HDL levels lower among Sri Lankans

Serum HDL cholesterol levels are lower among Asians than Caucasians and this may be one of the causes of high incidence of heart attacks among the young (those below 40 years) Sri Lankans.

Therefore Sri Lankans should limit the consumption of vegetable oils as much as possible as there is scientific evidence to show that excessive consumption of vegetable oils such as corn oil decreases the level of HDL cholesterol.

Epidemiologic studies suggest that raising level of HDL retards the development of an atherosclerosis (abnormal thickening of the walls of arteries due to fatty deposits on the inner walls).

In humans each increase of baseline HDL of 1 mg per decilitre is associated with 6% decrease in the risk of death from coronary heart diseases or myocardial infarction HDL cholesterol transports excess cholesterol from peripheral tissues to liver for excerption a process known as reverse cholesterol transport.

In addition, HDL inhibits the oxidation of LDL cholesterol (It is the oxidized LDL which is harmful) HDL may reduce the risk of thrombosis

How can you increase your HDL

Life - style modification

(a) Exercise: regular aerobic exercises (e.g. brisk walking, jogging, bicycling, swimming, etc.,) increase the HDL level in healthy (normal) sedentary persons and this increase is more in men with low HDL cholesterol and high triglyceride level and abdominal obesity. Weight loss may be crucial for an increase in HDL cholesterol to occur. You should take aerobic exercises for 30-45 minutes per day for at least 5 days of the week.

(b) Smoking Cessation: Smokers usually have low HDL levels and that is one reason for high incidence of heart attacks among smokers. After smoking cessation, there is a significant increase in the HDL level.

(c) Weight Control: Obesity in associated with low HDL cholesterol levels and high triglyceride levels. A reasonable weight loss goal for overweight or obese patients is one pound (0.45 kg) per week with a target body - mass index (BMI) of less than 25.

(d) Alcohol Intake: Moderate alcohol consumption (30 g or one fluid ounce of alcohol per day) increases the HDL levels by 4 mg per decilitre irrespective of the kind of alcohol. There is no scientific evidence to show that consumption of red wine is superior to consumption of other types of alcohol. Mild to moderate alcohol consumption (no more than one to two drinks per day) appears to be reasonable for many persons with low HDL cholesterol levels.

Sri Lankan doctors should be very cautious in advising our heart patients to consume alcohol in moderation as a significant proportion of these patients ultimately end up with complications of alcoholic consumption such as alcohol dependence (addiction to alcohol) and alcohol cirrhosis.

Gene for alcoholism appears to be common among Sri Lankans. Physicians should not advise Sri Lankans to consume alcohol if they have liver disease or if there is a family history of alcoholism. A significant number of my colleagues who used to consume alcohol in moderation during the medical school days have died following alcoholic cirrhosis.

(e) Dietary Fat Intake: Plasma LDL Cholesterol levels and HDL cholesterol levels both decline with reduction in the intake of dietary fat. The concomitant decrease in LDL that occurs with diet low in saturated fat may override the effects associated with decline in HDL.

Diet rich in omega 3 fatty acid and mono unsaturated fats such as olive oil, canola oil, soya oil, nuts such as cashew nuts, peanuts, walnuts, almonds, pecans, cold water fish (such as salmon and mackerel) and shellfish (e.g. prawns, crabs and lobsters) increase your HDL level and decrease your LDL cholesterol level.

Although doctors have been advising patients with elevated cholesterol to avoid consumption of shellfish in the past, latest research shows that consumption of crabs, prawns and lobsters in moderation is beneficial to patients with low HDL cholesterol.

Medication

Several drugs are known to increase HDL cholesterol and these include niacin (nicotinic acid) fibrates and statins and these drugs are also known to decrease serum triglycerides.

(a) Niacin: This is most effective drug to raise the HDL. Niacin improves the endothelial function and nitric oxide synthase activity, this vitamin is not very popular among Sri Lankan doctors and patients as it has several side - effects such as cutaneous flushing, elevation of blood sugar, loss of appetite and elevation of uric acid.

(b) Fibrates: Fibrates such as gemfibrozil and fenofibrate increase the HDL level and decrease the level of triglycerides (High triglyceride level in a coronary risk factor). Fibrates because of above effects prevent heart attacks and other coronary events and stroke.

(c) Statin: Drugs such as lovastatin, simvastatin, atorvastatin and rosuvastain which are used by doctors to decrease the LDL level also raise HDL cholesterol level slightly. Some physicians combine simvastatin with niacin or fibrates in case patients with very low HDL cholesterol.

In conclusion, low HDL level is an independent risk factor for cardiovascular events such as heart attacks, angina, and strokes.

Physicians should first try lifestyle modifications and medication should be tried only in high risk patients.

In treatment of patients with hyperlipidaemia, one should first attempt to bring down the LDL level and if HDL is still low they should try medication with drugs such as fibrates and statins which have various side - effects such as muscle damage (myositis) and liver toxicity.

Dietary items such as olive oil, soy canola, cashew nuts, peanuts, avocado, walnuts, almonds and cold water fish (such as mackeral and salmon) and shell fish should be recommended for those with low HDL level.

As gene for alcoholic addition appears to be high in Sri Lankans, Sri Lankans doctors should be very careful in recommending consumption of alcohol in moderation as our patients (some of them) may end up as alcoholics or get hepatic cirrhosis as majority of patients gradually increase the quantity of alcohol they consume after a period of time.

Cause for concern

World Cancer Day falls on February 4:

by Harshini PERERA

Cancer a malignant disease, has taken the lives of 16 million in the year 2000, with around 12,000 patients affected by it in Sri Lanka alone.

Researchers believe that by year 2020 the number will rise from the 10 million in 2000 to 15 million in 2020.

Therefore, the treatment of cancer has become the most urgent concern whereas prevention is all but forgotten. The World Cancer Day falls on the 4th February each year which ought to a painful reminder to us all.

Cancer is an unwarranted, uncontrolled growth of a group of cells which can either be a tumour harming other healthy cells.

The type of cancer very common in Sri Lanka are oral, breast, cervical, oesophageal, and the lung cancers. Dr. Wasantha Dissanayaka, Deputy Director of Cancer Hospital, Maharagama explained that, smoking, alcoholism, pollution has become the causative factors while chemicals, preservatives and radiation have aggregated the situation.

Many people in Nagasaki, in Japan became leukaemia patients overnight as a result of the atomic bombing in 1945 and others became prone to cancer even several years later. The Cancer Hospital treats around 800 patients a day.

“We had been successful in making this a pleasant place just like any other hospital. It gives you a peaceful surrounding and far away from the social stigma.” explained the deputy director.

The Hospital boasts of State-of-the-art equipment to obtain special reports like mammography, endoscopy, CT Scan, US Scan, to detect cancer at the earliest. Explaining further, he said that when one shows early symptoms like lump in the breast, sudden changes in the skin, difficulty in swallowing, persistent cough, changes in the bowel movements and irregular bleeding, he or she immediately consult a doctor.

The Government has spent Rs.750 million to provide the cancer hospital with a new linear accelerator treatment system. The machine is the latest in cancer treatment system to treat cancer without damaging healthy cells. There will be a stall open to the public at the Deyata Kirula 2009 exhibition, conducted by the Cancer Hospital.