Dr harold Gunatillake

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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A diet that makes you slim Written by Dr Harold Gunatillake: Health writer

Some of my readers have asked me to suggest the best diet for slimming. There are many diets described, each has its merits and demerits, but I find the ketogenic diet is one of the most practical and rewarding diets if you desire to slim. It is more a further extension of the popular Atkin diet with more restriction of carbs and added more fats, and is easy to follow.

We need carbohydrates, fats and proteins to provide energy for survival. In the normal traditional staple diet we consume carbs as the main calorie producing ingredient (60%), and about 30% of fats, which includes about 10% of saturated fat and 20% of unsaturated fat. Proteins are the bricks of your building structure and you need about 10%.

One could bring down the carb consumption to about 20% and increase the fats to provide nearly 80 per cent of the daily required calories In the traditional low carb diet protein content is increased whilst in keto diet the fat content is increased.

Why is it called the keto diet?
When your carb consumption is very low, the body turns round to the stored fats for energy. When fats are broken down the liver produces ketones to be used as energy. This is a natural survival kit in our bodies, to produce ketone bodies when we are deprived of energy producing carbs. WE are not really starving ourselves in this diet but only reducing the main energy producing carbs.
Fats being the main source of energy in keto diet, let’s discuss what fats should we consume to lean ourselves. You do not target the foods in the deep freezers in supermarkets for such required fatty food consumption. Such food contains trans-fat added to the foods to increase their shelf life. They increase a person’s cholesterol levels and increase inflammation in the body. These trans-fats are manufactured from vegetable oils and they go through about ten processes and hydrogen fumes are added on. So, they are also called hydrogenated fats, like margarine.

So, please avoid fatty foods containing hydrogenated fats when starting on a ketogenic diet. Those friendly saturated fats in a ketogenic diet are: coconut oil, grass-fed beef, butter from grass-fed cows: and whole milk and whole milk dairy foods.

Include more polyunsaturated oils in the cooking process, such as almond oil, flaxseeds, olive oil, and canola oil, corn oil and so on.
Eat plenty of oily fish and nuts in a keto diet. You could eat two eggs a day without fear of increasing your blood cholesterol level. 

The keto diet is not a high protein diet. They are not used to provide energy. As such you could eat the normal amount of protein foods daily, such as grass-fed meat products, nuts, seeds and eggs, among others

What carbs do you reduce to restrict carb intake. Keto diet recommends vegetables of the non-starchy varieties, and avoids potatoes, and other ground roots. Vegetables included are: artichoke, asparagus, baby corn, broccoli, Brussels sprouts, and eggplant, green beans, okra, onions, tomatoes, salad greens, spinach, arugula and so on. Carbs like pasta, noodles, bread and rice are not included in the keto diet. Fruits are also not included in the keto diet. The diet does restrict starchy foods but you may consume in very small quantities adding up to 20 per cent of your calories.
Coffee and tea are allowed without sugar. Sodas are not included due to the high sugar content.

Condiments such as yellow mustard, mayonnaise and hot sauces are okay provided you chose the ones without sugar. You could add the Asian spices, pepper chili, basil, and cilantro ad lib on a keto diet. 

Keto diet not only reduces your weight but also ideal diet for diabetics. You may not have to take any anti-diabetic medication, and control your blood sugar by choosing the right carbs. For instance, the Vegans find it easy to control their blood sugar levels. 

Seizures in epileptics
This diet reduces the seizure rate among epileptics. According to the Epilepsy Foundation in US, an estimated 50 per cent of children reduced fits by half on the ketogenic diet. Keto diet promotes heart health in addition to losing weight

Side effects
There are a few side effects with keto diet. Constipation could be one problem. High fibre greens and drinking lot of water may be the solution. It is not recommended for young people as it may retard growth. Formation of kidney stones is a possibility. Doctors do not recommend this diet for those having chronic kidney disease and gout. If you suffer from any chronic disease, you must talk with your doctor before beginning any new diet.

Conclusions: In this diet you transfer the main energy requirements to the stored fats in the body through a process of ketone bodies production in the liver for energy, depriving intake of carbs to produce energy. It is mainly a high fat diet.

(Some reference to the article on the same subject written by Rachel Nall, RN) New research Latest finding is that when it comes to shedding pounds, there is little difference between a low carb diet or a low fat diet. That conclusion comes from the tracking of roughly 600 adults who had been between 15 and 100 pounds overweight when they embarked on either a low-fat or low-carb supervised diet for a year. (ref: Medicine.Net)

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 Fellowship.

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Health Benefits of Garden Parsley – By Dr Harold Gunatillake

We have a balcony garden, growing many herbs, spinach, basil, chillies of various lengths, mukunu anna and so on. It is a great comforting feeling to see these plants grow in pots, watering daily, and the satisfaction is beyond imagination. We live in Sutherland, Sydney.


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