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Doctor my Legs are swollen? Written by Dr Harold Gunatillake-Health writer

Posted on 29 November 2017 by admin

Doctor my Legs are swollen?
Written by Dr Harold Gunatillake-Health writer.


Swelling of legs and feet are quite visible among women who wear sandals, especially among the seniors. It is not visible to men as they wear longs and shoes.


Dr. Harold Gunatillake

Most women are not aware of this swelling, as it is a slow process of collection of fluid in most situations, and do not bother until finding difficult to walk due to the heaviness. In certain situations, especially travelling, seated for long hours as in a flight you might get sudden swelling of feet and a concern to consult a doctor soon. This sort of swelling lasts for a few days, even at ground level, and should resolve within a few days. To prevent such quick swelling- start moving your feet around your ankles and walk down the aisle, a few times.


Swelling on the upper aspect (dorsum) of the feet and around ankles is due to too much fluid in the extracellular spaces. In most situations, there is too much of extra-cellular fluid in the whole body but is only visible in most dependent areas –below the knee extending to the feet. If neglected you may feel breathless on walking due to fluid collection in the lungs- we call, “pulmonary oedema”.


In situations where the cause is central, as in heart failure, or liver and kidney disease, both legs will swell. If one leg swells, obviously the cause is local. Sometimes, sleeping on one side continuously may gravitate the fluid to one leg and may appear unilateral masking the diagnosis.


You may be lacking proteins in your blood due to being on certain diets. Normally the sodium and water are kept within the blood vessels, and if you don’t have enough of a blood protein albumin, the fluids tend to leak out and collect in the extra-cellular spaces. In liver, kidney diseases the fluid will collect in these spaces due to lack of protein in these conditions.


In chronic kidney failure towards the ‘end-stages’ legs seem to swell due to retention of fluids, an early sign needing dialysis to rid the excess fluid accumulations.


A liver disease like cirrhosis can cause swelling of your tummy due to collection of fluid; we call it, ‘Ascites’ and swelling of legs and feet, too. The collection of fluid in your abdominal cavity is due to the obstruction to the veins (portal veins) that drains venous blood from the liver. The term, ’Portal hypertension’ is used to describe in such a situation.


The excess extra-cellular fluid is normally got rid of in the kidneys by using sodium and potassium. But having too much salt in your body retains that fluid and the kidneys may fail to rid the extra fluid. In this situation, you need to go on a salt reduced diet by cutting back on foods high in sodium. You need to lay off the salt-shaker on your dining table, and avoid eating treats like fried dry-fish with your rice and curry.


The normally functioning kidneys excrete about 100-120 quarts of fluid from the blood stream. With kidney disease protein will be lost, causing a situation called, ’Proteinuria’ meaning proteins in the urine that should not be there.


Retention of fluids and loss of protein through the kidneys can lead to oedema of legs due to both situations.


When you pass your 60th year, become breathless on walking with leg swelling, and racing heart, confusion and fatigue, the most likely condition the doctors will suspect would be heart failure. The heart muscles become weak and the pumping action is slowed.


Heart failure could be as a result of neglected high blood pressure, or a previous heart attack, or heart valvular disease, and irregular heart beating (arrhythmias).
In this situation in addition to swelling in your feet, ankles, legs, fluid collects in your lungs and abdomen, your heart will beat faster.


You need to see your doctor soon with such symptoms.
You could get localised swelling limited to one ankle after strains and fractures of ankle bones. In such an eventuality, you need to go to the out-patients casualty unit in your closest hospital for x rays and plaster immobilization. In a neglected situation, the strain could become recurrent, and the fractured bone surfaces may lead to arthritis.
When you stand or sit for long hours, gravity may pull down the fluid towards your dependant legs and ankles. This is exactly what happens during a long flight as mentioned earlier.
Hot weather also makes your ankles and feet swell mainly more due to dilatation of the minute blood vessels.
In bed-ridden patients lying down without much leg movements, a clot can form in the deep veins of your calves. Under normal circumstances with activities like brisk walking, the calf muscles work like the peripheral hearts to pump venous blood towards the heart. Clot formation in the deep veins of your leg is called ‘Deep Vein Thrombosis’ (DVT) quite a serious condition. Your doctor may strap your legs with crepe bandages or make you wear firm socks and give you intravenous heparin after admission to the hospital.
DVT can give you swelling of legs and ankles.
Several kinds of drugs can bring about leg and ankle swelling as a side effect. They include pain relievers, called non-steroidal anti-inflammatory drugs (NSAIDs) like ibuprofen, naproxen and aspirin. High blood pressure medications can give rise to leg swelling, especially the calcium inhibitor medication for the heart like amlodipine and peripheral vaso-dilators like vasopressin.
Long-term steroids and oestrogens also can give rise to legs swellings.
There are diabetes drugs and antidepressants that can make your body hold on to extra fluid, which can cause leg swelling.
During pregnancy, it is common to retain excess body fluids. This is mainly due to the changes in hormones, a temporary phenomenon that resolves after pregnancy. Such swelling may be due to a dangerous condition called preeclampsia. Alert your doctor immediately, if sudden swelling develops during pregnancy.


Lymphedema
So far the conditions mentioned for the cause of leg and feet swelling is due to the fluid collection with an excess of salt.
In this condition, if you press firmly with your thumb on oedematous area under the skin, an imprint or a dent is created. We use the word ’pitting’ to describe this sign. So the general term ‘pitting oedema’ is used.
Fluid may accumulate in your dependant areas due to stasis of lymph, too.
In addition to the blood vessels including arteries and veins, there is another circulatory system called the lymphatics. These are the invisible string like strands under your skin and deeply approximating the main blood vessels. These lymphatic paths are interrupted by glands called ‘lymphatic glands’. They are like railway stations and the lymphatic streams are like the railway lines.
These lymphatics participate in the conduction of nutrients and mainly in the defensive function of safeguarding against enemies. It forms part of the immune system in your body.
So, in lymphedema there is a build-up of lymph due to blockage or damage to the lymph system, i.e. the railway lines.
In cancer these lymphatic streams can get blocked. After surgical ablation of organs and tissues, too these lymphatic streams can get damaged and block the lymph drainage.
A good example is breast cancer where there is lymphatic blockage in the armpit, causing the many lymph nodes to become swollen and palpable. This blockage causes lymph in your arms to get blocked also, as they all drain into the lymph system in the arm-pit.
So now you can understand why women get big arms due to blockage of lymphatics after surgery.
A similar situation in the lower limbs too causes swelling of feet and legs. We call this ‘lymphedema’ of the legs. In Sri Lanka, this was quite common along the coastal regions due to a chronic inflammatory condition of the lymph caused by the filarial germ.
The legs become massive, and even the scrotal skin can get affected in men, and they become huge to sometimes the size of a football.
Swelling of legs and feet in this situation does not show signs of pitting, and hence called brawny swelling

 

Treatment
Swelling of feet and ankles may be painful, limits your joint movements, feel heavy to walk.
Initially, for any such swellings there are home remedies. RICE is an acronym that stands for rest, ice, compression, and elevation. These strategies are useful in case of an injury.
For fluid retention due to medical conditions mentioned earlier, you need to take a diuretic like Lasix to get rid of the fluid fast to feel comfortable.
Your doctor will do the necessary investigations to find the cause of swelling, and you may need life-long specialist treatment for chronic swelling of legs and feet.


Conclusions: Hope this article benefits those who suffer from chronic or recurrent swelling of your legs, and the need to see a doctor is explained.

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Health & Views – November 2017 by Dr. Harold Gunatillake

Posted on 20 November 2017 by admin

Dr. Harold Gunatillake

Health & Views Newsletter – November 2017 authored by Dr. Harol Gunatillake of Sydney, Australia. 

Please download pdf document

Health Views – November 2017

Dr. Harold 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) and a Government scholar for higher studies in UK.

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Insulin Resistance – by Dr. Harold Gunatillake, Health Writer

Posted on 16 November 2017 by admin

Insulin Resistance – by Dr. Harold Gunatillake-Health writer.

These two words you find in articles in relation to diabetes. Do you know what they really mean, and how serious it could be in relation to your health and wellbeing?

Insulin is a hormone secreted in specific cells called islet cells in the pancreas gland lying behind your stomach, in the upper part of your abdomen.

Its function, among other things, is to secrete the hormone to match the amount of carbs and soluble sugars you consume. If you eat too much of carbs and sweets daily, you do strain the pancreas to secrete more, and that situation insulin could become resistant in acting towards excessive blood sugar. 
The most common reason why you get insulin resistance is consuming excessive carbs and foods containing added sugars, on a daily basis. Yes, the pancreas will then increase the production of insulin. With time even with increased make of insulin, the blood sugar may not be brought to normal levels. This is the situation where we say that the pancreas is strained to produce an inferior less active variety of insulin which is resistant to maintaining a normal sugar level in your blood.
Insulin has no influence in the metabolism of fats and proteins, directly.
The main function of this hormone is a true ‘courier service’ accompanying glucose in your blood to the fat cells, liver, muscles and so on. If the pancreas does not produce sufficient amount to cope with the demand of glucose from digested carbs, then sugar will accumulate and float in your blood, leading to many complications as seen in people with poor diabetic control. This excess accumulation is called, ‘hyperglycaemia’.
In a situation, where the pancreas secrete insulin more than required and hyper-sensitive, or as in tumours called insulinomas, or when taken overdose of insulin accidently, the sugar level will drop in your blood. This condition we call, ‘hypoglycaemia, a dangerous situation to be in.

Both these situations could arise among diabetics on insulin therapy.
So long as the insulin secretion goes hand in glow situation with glucose physiologically, the blood glucose level will remain at the normal range.
Your normal fasting glucose level when checked with your glucometer will give a reading of a range between 80mm/dl to about 110mm/dil. (5.5mmols).
When your sugar level reaches 126mm/dl, then you qualify to become a ‘pre-diabetic’ by definition, also called ‘spring diabetes’.
You could have no symptoms with insulin resistance, for a long time. The first sign could be dark patches of skin on your neck, elbows, knees and hands.
Your chance of getting insulin resistance can increase if you do not daily exercise, have high blood pressure, or smoke. It is possible to get insulin resistance with low HDL (good cholesterol), or high levels of fat (triglycerides) in your blood. You could even end up with heart disease, stroke and peripheral vascular disease.

Some people may be resistant to insulin due to a history in the family. If your parents have diabetes, it is most likely that you would get insulin resistance.
The easiest test to check whether you have insulin resistance is to take a sample of blood, fasting or otherwise and check the blood sugar level. You could also have a blood test called ‘HbA1c” to check the average level of your blood sugar during the past three months. If the numbers are high, will suggest you have insulin resistance.
Eating too much carbs and sugars strains your pancreas to secrete more insulin. This strain for a long period may produce insulin that could become resistant to glucose. The pancreas may have to work overtime to produce more insulin to compensate for the resistance. If further neglected, the pancreatic cells that make insulin can burn out, leading to diabetes. In such a situation you may need insulin therapy in the injection form to control your blood sugar, on a daily basis.

Your Diet
You need to cut back on processed or refined grains (rice and wheat products), having a high glycaemic index and substitute with vegetables, whole grains and some fruits. In short, you need to go on a low carb diet (40grams/per day) like the diet formulated by Atkin. The DASH diet, for people with high blood pressure, with low carbs seems to be another preferred one. On the latter diet you cut down on your salt, too which helps you to lower insulin resistance. Another beneficial diet is the Mediterranean one- uses lots of veggies and fish, chicken, nuts, olive oil whole grains and legumes.
Watch your calories and glycaemic load (GL), cut back on fried foods, sugary drinks (sodas) and salted processed foods.

Exercise
Physical activity helps you to lower your insulin resistance. Strength and stretching exercises as in a gym work-out increases glucose absorption for quick energy, and lowers the insulin resistance, too

Lifestyle changes
Lifestyle changes for better with low carb, low fat, high protein diet, with exercise and fresh air are the best treatment for insulin resistance. If you develop diabetes, you may need a drug like metformin to reduce the blood sugar level through the intervention of your liver. This drug also prevents or delays type 2 diabetes for younger obese people.

Metabolic Syndrome
If you are overweight ( a large waist-line), with high blood triglycerides, low HDL (good cholesterol), high blood sugar, and blood pressure, you are categorized as having, ’metabolic syndrome’ Insulin resistance is an important sign of this syndrome, and it raises your chance for diabetes, heart disease, and stroke.

Inflammation
People having insulin resistance have a high level of chronic inflammation throughout your bodies, and more prone to blood clots in your arteries, liver disease, and rheumatoid arthritis, among others.
Conclusions: Changing for a healthier lifestyle and being aware of the condition may help you to avoid insulin resistance.


Dr. Harold 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) and a Government scholar for higher studies in UK.

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Dr. Harold Gunatillake: How do you differentiate between Bacterial and viral infections

Posted on 11 November 2017 by admin


Written by Dr Harold Gunatillake-Health writer.

Dr. Harold Gunatillake

You are in the wilderness, there are no doctors or hospitals in the vicinity, you are carrying antibiotics with you, so the dilemma is to put your thinking cap on and decide on taking or not, of those antibiotics in your bag, during the time of an infection like high fever.

This article will ease that situation for you.

Let’s first get familiarized with these germs. Bacteria are not visible to the naked eye; you need to look for them under the microscope. They are single-celled organisms found everywhere, in every country in the world, in the air, some in water or soil. They are living within you dormant till your immune system gets weak to attack you. Some of these bacteria are beneficial and serve vital functions for the environment. For instance, there are trillions of them in your small and large gut, protecting you. They could be your best friends you bring along from your mother’s birth passage and mother’s milk. They make vitamins in the gut for you; they boost your immune system, and also make your gut, less hospitable to bad bacteria.

Bacterial infections are caused by harmful strains of bacteria in your body. Common diseases produced by these bacteria are Pneumonia, meningitis food poisoning and so on. The thick-walled ones are called ‘Gram-positive’ bacteria whilst the gram-negative ones the wall is not thick.

Viruses are different types of micro-organisms. They are much smaller and cannot multiply on their own, unlike bacteria. All they have is a protein coat and genetic material like RNA or DNA. Viruses need human or other animal contacts to survive, unlike bacteria. Viruses attack specific organs in your bodies, such as the liver, respiratory system, or your blood. When you get flu symptoms, it is always a virus attacking your respiratory system, causing a cough, runny nose, hoarse voice, and breathless. The flu virus has its own lifespan and no antibiotics will relieve or expedite the illness.

From your symptoms, you should be able to differentiate between a bacterial and a viral infection. If you get a runny nose (coryza), cough, sneezing, tiredness, and headache you could guess it is a viral cold with sinus affection.

If there is a skin infection, like redness and swelling due to cellulitis then it’s most likely due to bacterial infection. Infection of the hair follicles as in pimples is always due to a bacterial infection.

If you get nauseas with or without vomiting, loose motions and fever and abdominal colic, it is more likely a bacterial infection and we call it food poisoning. If it starts with nausea and vomiting without loose motions, it would be something that you ate within hours. On the other hand, with same symptoms you get abdominal colic and diarrhea, it is most likely food poisoning that you ate the previous day.

These bacterial infections are caused by raw or semi-cooked meat, fish, eggs, stale food and unpasteurized dairy kept outside the fridge for bacteria to grow.

Sexually transmitted disease is generally bacterial in origin. Chlamydia and gonorrhea are such infections and bacterial in origin.

Middle ear, infection of the brain membranes (meninges) and urinary tract infections (UTI), are caused by bacteria.

You can always differentiate between a bacterial infection and a viral one by palpating your radial pulse count in the wrist. If you have a fever with a rising pulse count- say over 100 per minutes, it is most likely a bacterial infection. If the pulse is slow with high fever, it is always a viral infection.

The above information will give you a clue whether to take those antibiotics in your bag, if it is bacterial in origin, and not take them if a viral infection is suspected.

So remember, antibiotics fight bacterial infections. Antibiotics are not effective to viral conditions. If you feel that there is a secondary bacterial infection after having a viral infection for a few days and not resolving, it is reasonable to take antibiotics you carry to help cure the secondary infection which may boost the immune system to cure the viral condition.
 

Antibiotic resistance
Overuse and misuse of antibiotics lead to antibiotic resistance. This means that such antibiotics may not work when such medication is required. Antibacterial –resistant infections are potentially dangerous and increase the risk of death. So, it is important to know when you should take them. It is best for your doctor to prescribe the specific antibiotic to kill an infection, and it is also important that you finish the course, without stopping when feeling better in a day or two.

Antibiotics may resolve your bacterial infection, but they also kill the beneficial bacteria in your gut. So, today doctors advise you to take probiotics like low fat, unsweetened ‘Greek’ type of yogurt, after a course of antibiotics to cure your bacterial infection, to regrow the good gut bacteria (microbiota)

In the wilderness, it is advisable to visit the closest food outlet and enjoy yogurt daily, and that may reduce the risk of developing bacterial food poisoning.

To prevent viral infections like polio, measles and chicken pox vaccines have been developed. Vaccines can prevent such infections such as the flu, hepatitis A, B and human papillomavirus (HPV) and others. Vaccines are not given prophylactically to prevent bacterial infections.

Conclusions: This article helps you to differentiate between bacterial and viral infections even before doing further investigations. If you suspect a viral condition you need rest and temporize with over the counter medications. Avoid antibiotics like the blazes.

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Health tip: How Often Should You Check Your Pulse?

Posted on 10 November 2017 by admin

Health tip for the day- by Dr. Harold Gunatilake – How often should you check your pulse? 


You should check your pulse rate in your wrist at the base of your thumb once in a while, to detect changes that would warn you if a suspicious disorder of the heart or other endocrine dysfunction is brewing to call your doctor. At rest, in a normal healthy person, the pulse rate would range between 70 and 80 per minute with an average of 72 per minute. As a lay person, how can you suspect any disorder by feeling the pulse? The easiest way to feel the pulse is to place the index and mid-finger on the outer aspect of the inner (ventral) side of the wrist (shown in picture) and keep moving until you feel a thud. That would be your pulse detectable in your radial artery on the wrist. Next, you roll your two fingers over the artery to get more information. Palpating the radial pulse at the wrist gives an indication of the state of the coronary arteries: after all, these vessels are branches of the same tree. If you feel that the radial artery is hard and thick that would be a sure signs that your coronary arteries are also in the same situation. The soft arteries become thicker due to aging, eating the wrong diet- high sugar and high fat, alcohol, stress and high blood pressure. You will be surprised that fish oil containing omega-3 fatty acids seem to soften the arteries. Take regularly, a minimum of 1000mg. daily. Some may get side effects such as stomach upsets and heartburn when taken on an empty stomach. You might once in a while feel a drop in your heart (pulse) rate. If the drop is one in about 10 beats, you don’t have to worry, it may disappear in time. But if those dropped beats are more frequent-say one in five, you need to see your doctor soon. Other causes of irregular pulse rates are –Atrial fibrillation, supraventricular tachycardia, and ventricular tachycardia. So with irregular pulse rates or drop beats you need to call your doctor, soon. If you have a rapid heart rate over 80 at rest with exercise it may drop to the normal range. If the rate is over 100, obviously you are straining your heart and you need 
 
to see your doctor, sooner. The over-active thyroid is a common cause of rapid pulse. Are you stressed and suffer from anxiety? In such a situation you secrete more, a hormone called nor-adrenaline from your adrenal glands sitting on your kidneys that will make your heart go rapidly. Symptoms in a panic state could be a racing heart, sweating, chest pain and also breathlessness. You need to see your doctor to get medicine to calm you down. If you don’t exercise regularly, your pulse will be in the range between 80 to a 100per minute. You need to do a workout daily, to strengthen your heart muscles. During exercise, your heart will pump rapidly and with training, the rate slows down rapidly. If you don’t work out regularly and start again you might have a heart flutter- a pounding effect in your chest. Your pulse rate may be irregular, but with regular training, the pulse becomes slower, steadier and regular. Your pulse rate can go rapidly after your morning coffee for some people. As you know, caffeine in coffee is a stimulant that raises your heart rate. You could experience the same with sodas, chocolate, and tea. Smokers will always have a rapid heart rate, and quitting is the best solution. Women can have a rapid pulse rate during their period, with pregnancy and closer to menopause. With high fever due to bacterial infections you invariably get a rapid pulse beat. On the contrary with viral fevers, the pulse get slower, common-sense way of differentiating the two.  Some medications, including the over the counter ones, may give a rapid pulse rate as a side effect. Examples include: antibiotics, antifungal medicine, asthma inhalers (salbutamide) over the counter cough and cold medicine, diet pills and so on. There is one medicine that doctors prescribe to slow the heart rate, called beta-blockers. They are beneficial to bring down your rapid pulse in a short while) If you are a diabetic, in low sugar situations (hypoglycaemia), you may feel unsteady, uncomfortable, lifeless and have a rapid pulse rate. In this situation, your body releases stress hormones like adrenaline to prepare for an emergency food shortage. As mentioned earlier an over-active thyroid can make too much of hormone thyroxine in the gland to produce a rapid pulse rate, shiny, sweaty skin, bulging eye and so on. Taking too much of thyroxine to treat an under-active thyroid gland can cause it. 

Chronic alcoholics have a rapid pulse rate. For some, an occasional drink can cause a rapid pulse rate which settles down in a few hours. This condition is nicknamed, “holiday heart syndrome”. Illegal street drugs like amphetamines, cocaine, and ecstasy can cause a rapid heart and cause damage to the heart muscles. Conclusions: Check your radial pulse once in a while. Stay healthy, exercise daily, enjoy an occasional glass of wine, and take your medications at regular times, for a good lifestyle and longevity. Hope this article will benefit you. 

Dr. Harold 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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Eating Red Meat is bad news by Dr Harold Gunatillake-health writer

Posted on 24 October 2017 by admin

Eating Red Meat is bad news!

Trimethylamine N-oxide (TMAO) test to check on risk of serious heart problems.
Written by Dr harold Gunatillake-health writer.


When you are admitted to Casualty as an emergency with chest pain, doctors, in addition to performing various investigations does a test to measure the blood levels of a molecule called trimethylamine N-oxide (TMAO). Positive results of this test are a sure sign of a heart attack or even death. Prognosis and seriousness of the episode can be assessed by the medical team, from this test alone. 


This study was published in the European Heart Journal (Jan.10:2014).

TMAO is naturally found in fish at high levels. Humans do not produce this compound, but it is the gut microbes called firmicutes help convert the nutrient choline (from eggs) and carnitine from meat to produce this compound.


There are over ten trillions of beneficial microbiota in our gut looking after our health and welfare, breaking down of our food to feed them and us. All gut microbes love high fibre food (prebiotics) and fermented foods with certain bacterial cultures as in Kombucha, Kimchi, kefir, yogurt, miso and others. (Probiotics). Firmicute bacteria are a special kind of gram positive bacteria with thick walls found in the large gut among the other microbes.

If you eat meat and eggs regularly, the thick walled gut bacteria called firmicute produce TMAO from choline and carnitine respectively, as mentioned earlier. 
It has also been revealed that those who eat meat, dairy and eggs have elevated TMAO levels in the blood and also higher levels of firmicute bacteria in the gut.


Compound TMAO seems to be an ‘inflammatory’ molecule and increased levels in your blood cause peripheral artery disease (PAD), increased risk of blood clots and increased cardiovascular death and mortality.
It was found that when patients are seen with chest pain caused as a result of heart disease the TMAO levels in the blood seem to be very high. It was revealed that with such high TMAO levels the prognosis of the condition can be assessed. Those having very high levels are likely to die, have a heart attack or stroke or need blood vessel surgery soon.


Do not confuse this compound with troponin T levels done on patients with chest pain. The researchers also found that a patient who did not appear to have elevated levels of troponin T when they first arrived at the hospital, those with high TMAO levels had a six-fold higher risk of a major adverse cardiovascular event.
Among vegans the TMAO levels in the blood are insignificant.


Conclusions: Be aware that eating too much of red meat, dairy and eggs can increase the firmicute germ in your gut that produces excess amounts of the harmful TMAO in your blood. The level of this compound is high among those having heart attacks, stroke, and blood clots in the arteries.


This article does not discourage you from eating red-meat treats, eggs or dairy, but emphasis the awareness of the dangers and to moderate your requirements.

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, Bachelor of Medicine & Surgery (Cey). Government scholar to UK for higher studies and work experience

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Health & Views by Dr. Harold Gunatillake

Posted on 09 August 2017 by admin

It is said that bipolar disorder is caused by a chemical imbalance in the brain, is there an actual test with accurate results for bipolar? The term “chemical imbalance” is my least favorite term in all of pop psychology/psychiatry. The “chemicals” of which people refer to are actually called “neurotransmitters.” Neurotransmitters are a substance in the brain that allow for the electrical conduction and transmission of signals between brain cells (or, “neurons”). There is no test for chemical imbalance in the brain for any disorder because no one knows how much of any neurotransmitter is optimal, and it varies from person to person, and the neurotransmitters themselves are not in stagnant amounts, and we need different amounts in different parts. Some neurotransmitters also function as hormones (or you could say that they are hormones that function as neurotransmitters). These neurotransmitters have a chemical composition (so does your desk chair), but they are not liquids in the sense that they can be measured in volume. In fact, they are molecules. 

For complete article and more, please open Dr. Harold Gunatillake's Health & Views in the pdf below.

Health & Views August 2017 by Dr. HG
 

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Healthy Lifestyle by Dr. Harold Gunatillake

Posted on 21 July 2016 by admin

Hints for managing the common cold – Dr. Harold Gunatillake-health writer

Nasal irrigation for your nasal blockage with the common cold
Nasal inhalation of steam does very little to release the nasal congestion and a waste of time.
Instead, nasal irrigation which washes the nasal cavity with saline or sterile water to flush out the mucus relieves the symptoms of congestion and blockage.
Do not rush to the doctor with a cold, being a virus condition and when antibiotics are contraindicated.
The threat of global antibiotics resistance is very real due to over-prescription of antibiotics for the wrong reason.
Each cold (coryza) has its lifespan about a week. Rest, nutritious food, warm chicken soup, with zinc and vitamin C supplementation without OTC drugs and visiting the doctor for antibiotics is recommended.
With the virus spreading to the lungs you may need antibiotics if the doctor suspects secondary bacterial infection.

 

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Healthy Lifestyle by Dr. Harold Gunatillake

Posted on 19 July 2016 by admin

Look after your kidneys.
Our kidneys are marvellous organs and we take them for granted, and more concerned about the health of our hearts and cholesterol levels. Even when you harm the kidneys, they are desperately trying to help you, even after 80 per cent of the kidney tissue is damaged.
They re-absorb minerals and nutrients from your filtered urine, produce hormones, and excrete waste products and toxins from your blood and maintain the pH of your blood.
Drinking too much of Soda drinks can harm your kidneys. Too much caffeine in coffee, tea and soft and soda drinks causes your blood pressure to shoot up and your kidneys will suffer.
Cut down on added salt in your food. Excess salt increases the BP and strains your kidneys.
Kidneys need lots of water to function well and to flush the excretory products The National Kidney Foundation recommends drinking at least 10-12 glasses of water every day.
Magnesium deficiency increases absorption of calcium through the gut and develops kidney stones Take magnesium in tablet form daily or eats plenty of leafy vegetables, seeds, nuts and beans. Fresh avocados are full of magnesium.

Lack of vitamin B6 damage your kidney functions. According to a study carried out at the University of Maryland, a vitamin B6 deficiency increases the risk of the formation of kidney stones. Vit B6 is found in fish, liver, potatoes, starchy vegies, chickpeas and non-citrus fruits.

Too much of pain-killers like aspirin, paracetamol, non-steroid anti-inflammatory drugs can damage your kidneys. Restrict and take them occasionally.
Statins can cause damage to the kidneys- be aware.
If you suffer with diabetes and high blood pressure you need antihypertensive drugs like ACE inhibitors and ARBs and tight sugar control is essential. You need to do blood tests like creatinine, eGFR, urea, electrolyte levels in your blood, and micro-albumin in your urine. Get these check-ups regularly- neglecting them may end in end-stage failure of kidneys and then dialysis will be imminent.
Limit your daily alcohol intake, and most herbal medicines may damage your kidneys.


Hints for managing the common cold
Nasal irrigation for your nasal blockage with the common cold
Nasal inhalation of steam does very little to release the nasal congestion and a waste of time.
Instead, nasal irrigation which washes the nasal cavity with saline or sterile water to flush out the mucus relieves the symptoms of congestion and blockage.
Do not rush to the doctor with a cold, being a virus condition and when antibiotics are contraindicated.
The threat of global antibiotics resistance is very real due to over-prescription of antibiotics for the wrong reason.
Each cold (coryza) has its lifespan about a week. Rest, nutritious food, warm chicken soup, with zinc and vitamin C supplementation without OTC drugs and visiting the doctor for antibiotics is recommended.
With the virus spreading to the lungs you may need antibiotics if the doctor suspects secondary bacterial infection.
Harold Gunatillake-health writer


 


16 July at 21:47

How To Cope With Positional Vertigo | The Sunday Leader
A sudden drop of blood pressure when you get up from a seated position causes dizziness due to the sudden momentary drop of circulation to the brain.

Please eat beetroot in salads or cooked daily. Nitrites in beet lowers your blood pressure
Take magnesium daily -also lowers blood pressure.Unfortunately Magnesium supplements are not imported to Sri Lanka. Get a overseas friend to send. Alternately eat nuts, dark green vegetables like spinach daily. Cashew has magnesium, unfortunately too expensive to eat daily, in Sri Lanka.

Dr Harold-Health writer

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Healthy Lifestyle by Dr. Harold Gunatillake

Posted on 18 July 2016 by admin

Blood Pressure words on a thermometer measuring your hypertension, with level rising past normal, elevated and danger to burst at maximum point

Blood Pressure words on a thermometer measuring your hypertension, with level rising past normal, elevated and danger to burst at maximum point

Do you know almost all strokes are preventable? High blood pressure is the most important modifiable risk factor. You need to check your BP every six months, because early stages increasing blood pressure has no symptoms. The body gets used to the gradually rising BP, until one day the warning sign (giddiness) is given for the impending stroke. Don’t wait for it. Prevent it. The causes of hypertension are many: inactivity, poor diet, obesity, smoking, heart causes, diabetes, alcohol, and stress among others.
These are all controllable
Dr Harold-Health writer

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