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| Friday, 15 November 2002 |
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WHO - on genetically modified foods : Approved toxin limits and guidelines Health watch recently had several letters from the public, calling for any information we have on health implications of genetically modified food which are now available for the public in most of the countries.
This being a currently discussed topic even in this country, we were able to get the following document from the WHO office in Sri Lanka on the topic. This document containing observations and recommendations made by the Codex Alimentarious Commission on safety assessments of genetically modified foods has been issued by the WHO as a press statement in July 2001. The Codex Commission had agreed in principle that the safety of food derived from genetically modified organisms (GMO) should be tested and approved by governments prior to entering the markets. In particular GMO foods should be tested for their potential to cause allergic reactions. Mr. Alan Randell, Secretary of the Commission has said "The work of the Codex Commission on toxic substances is particularly important given the long term health risks for consumers, especially children". The Codex Alimentarius Commission has agreed on the first global principles for the safety assessment of genetically modified foods, on maximum levels of certain food toxins, and on guidelines for organic livestock production, the UN Food and Agriculture Organization (FAO) and the World Health Organization (WHO) said in a joint statement today. The Codex Commission agreed in principle that the safety of food derived from genetically modified organisms (GMO) should be tested and approved by governments prior to entering the market. In particular, GMO foods should be tested for their potential to cause allergic reactions. "This is the first global step toward the safety assessment of genetically modified foods," said WHO Director-General Gro Harlem Brundtland. "International agreement on how to perform risk assessment of genetically modified foods will help all countries, especially developing countries," added Dr. Brundtland. The 24th session of the Codex Commission will close on Saturday afternoon. The Commission is a subsidiary of FAO/WHO with 165 member states. The Commission also approved a series of new maximum levels of environmental contaminants, particularly lead, cadmium and aflatoxin, found in food, such as fruit juices, cereals, and milk. "The work of the Codex Commission on toxic substances is particularly important given the long-term health risks for consumers, especially children," said Alan Randell, Secretary of the Codex Commission. "For example, lead is detrimental to the intellectual development of young children and the new standards adopted by the Commission definitely improve the current situation. Nevertheless there is more work to do and the Commission will continue to work on the issue," Randell said. maximum levels of aflatoxin in milk The Codex Commission also set maximum levels of aflatoxin in milk and milk products. Aflatoxin is a carcinogenic substance that can be transmitted from animal feed (for examples, peanuts and corn) into milk. The new maximum limit for aflatoxin in milk is 0.5 micrograms per kilogram. Some countries argue for a stricter aflatoxin limit of 0.05 micrograms per kilogram. However the majority of countries agreed that the higher limit was more feasible, particularly in developing countries. The Commission agreed to review the standard once there is new scientific evidence on aflatoxin health risks. "Given the amount of dairy products that are consumed world wide- especially by children - it was crucial to set a global standard for aflatoxin," said Tom Billy, Chairman of the Codex Commission. organic livestock production The Codex meeting also agreed to new guidelines for organic livestock production. According to these guidelines, organic livestock farming should aim to use natural breeding methods, minimize stress in animals, prevent disease, and progressively eliminate the use of certain chemical veterinary drugs, including antibiotics. Animals should mainly be fed with high quality organic feed, not meat and bone meal, although fish and milk products are acceptable. The use of growth hormones is not permitted. The Commission adopted a strategic framework that places greater emphasis on food safety issues in developing countries. Members welcomed efforts to enable developing countries to build their own food quality and safety systems. In that regard, FAO has initiated a Global Facility on Food Safety and Quality for the Least Developed Counties to strengthen their national food regulatory systems and their competitiveness in international food trade. Meanwhile, the WHO has proposed the creation of a trust fund to increase the participation of developing countries in Codex. While Codex standards, guidelines and recommendations are voluntary,
they are recognized by the World Trade Organization as reference points in
international trade disputes. On that giddy feeling Dr. Mendis will answer any readers queries on giddiness and other neurological conditions. Send your questions to Co-ordinator, Health Watch, Daily News, Associated Newspapers Ltd., No. 35, D. R. Wijewardene Mawatha, Colombo 10. Dr. Githanjan Mendis MBBS. MD(Cey) FRCP (Eng) FRCP (Edin) Consultant Neurologist speaks on the medical condition vertigo or giddiness as it is commonly referred to by the general public:- This medical condition generally affect the elderly. The young too can get it. So they too will have to be cautious. Supposing if you happen to be one of these patients, you will experience a kind of faintish feeling first you'll be feeling your surroundings just turning round, or you may feel the reverse that is you will be turning and not your surrounding. You may get it suddenly, or you may get it in short outbursts or intermittently. When you get it you'll feel as if you are going to fall, and you'll want to lie down. The cause for this condition could be either intermittent slowing of blood supply to certain parts of the brain due to narrowing of a blood vessel, or due to a sudden slowing down of the pumping action of the heart. Apart from that some ear infections could also cause it. In this ear condition the patient will hear some kind of noises in the ear. This is called - Tinnitus. Some brain disease could also cause it, where the affected part of the brain will steal most of the blood coming to the brain, causing a paucity of blood to other parts. These patients will also get cervical spongylosis, due to impinging of blood vessels in the neck. This will cause difficulty of posture of the neck. These patients should be careful when turning the head when sleeping. When sleeping they should slowly lie-down on bed, and when getting up also the same should be followed. Investigations done when treating these patients include x'ray of the neck. Brain scan CT/MRI in some cases, hearing tests also will have to be done. These patients can be treated with physical therapy, traction and drugs to push blood circulation up. Surgery is rarely needed. Some people who have mild attacks, neglect this condition, but it is
always best to consult your family doctor and follow his advice. Centenarian in Jaffna honoured The Ex-Bankers' Association of Sri Lanka and "Ageing Gracefully Society" jointly honoured a centenarian in Jaffna who has completed 101 years on the International Year of the Elders on 1st October, 2002 at the Jaffna College Undergraduates Hall, situated at Hospital Road, Jaffna. The Senior Attorney-at-Law of the Jaffna Bar Association, Mr. S. Kanagaratnam, who is an Octogenarian, garlanded him and the dignitaries of all religions - Hindu, Buddhist, Muslim and Christian - all blessed him. Dr. S. Kumaravel, Secretary, Government Medical Officers' Association, Jaffna together with Dr. P. Brighton of the Jaffna Teaching Hospital examined the Centenarian, and has submitted a report. *** Medical Report of Sinnathamby Arumugam Age:- 101 Yrs Examined by Dr. S. Kumaravel, Secretary Government Medical Officer's Association, Jaffna Branch and Dr. P. Brighton, Jaffna Teaching Hospital on 2nd October, 2002. Diet:- Vegetarian for last 50 years. Habits:- No smoking, no alcohol, Daily Meditation (Worshipping early sunrise), Fasting on Fridays, Sticks to time. Recently two syncopal attacks only. Physical Condition:- Vision, Hearing impaired recently Mobility affected - Needs assistance Cardiovascular System within normal limits Pulse rate - 88/min regular and good volume Blood Pressure 120/80 Respiratory system - lungs - Air entry equal adequate, clear Abdomen Nervous System - Vision impaired - hearing impaired Locomotor System - Impaired Walking - Needs assistance for walking No significant major illnesses in the past. Positive - Vegetarian, Non Alcoholic & Non Smoker Meditation,
Systematic Life. To stay heart healthy : Take to a vegetarian diet - says Consultant Cardiac Surgeon from India
Dr. Chishti's one advice to stay heart healthy is to take to a vegetarian diet. He says - eating fresh vegetables and fresh fruits with walking exercise is ideal for good health and long life. According to Dr. Chishti those of us who are in the South East Asian region are prone to heart disease more than the others owing to a genetic defect we inherit. Therefor it is advisable for all of us who are over 40 to get health check done annually. He also advises us to avoid deep frying of food, instead to stew and eat, whatever we want to fry. On the coconut oil issue, his view is that there being several risk factors for heart disease, avoiding one is not going to make a difference. On the argument put forward by some that our fathers and forefathers for generations have been using coconut and coconut oil in food, without any adverse effects, so how can it be bad for us now. Dr. Chishti says their life style was far different to ours. They were doing lot of hard work, sweating and walking and thus burning up the fat. But what are we doing today. Working in airconditioned rooms, going about in airconditioned vehicles, watching TV most of the time we have for leisure, so the fat accumulates. He advises fifteen minutes of brisk walking a day for everybody and avoid smoking and other risk factors. Lipid lowering drugs controversy by Dr. D. P. Atukorale I am very grateful to the Family Physician Dr. Sarath Paranavithana for writing an article referring to my article in the Health Watch in which I have advised patients over 70 years to avoid taking cholesterol lowering drugs because of the high mortality due to these drugs in the elderly. Dr. Sarath Paranavithana (SP) has given some references (MRC/British Heart Foundation Trial) and has come to the conclusion that my advice regarding cholesterol lowering drugs "is not quite correct". He goes on to say that abovementioned trial" will put a stop to any medical debate about the value of statins in the elderly." It is not correct for anyone to say that any research group has the right to put a stop on any medical debate as what cardiologists, researchers and family physicians believe as the last word today may be out-of-date tomorrow because medicine especially cardiology progresses by leaps and bounds. Again SP's statement that "statins are not outrageously expensive" is not quite correct. In Sri Lanka statins are expensive and most cardiac patients cannot afford to buy these expensive drugs. SP's statement that "a statin a day keeps that doctor away" is not like the statement "an apple a day will keep the doctor away" and SP's above statement is grossly erroneous and misleading the readers because statins have a large number of side effects such as hepato-toxicity, flatulence, myositis, diarrhoea, constipation, dyspepsia, dizziness, blurred vision, headache, muscle cramps myalgia, abdominal pain, fatique, pruritus, dry mouth, insomnia and rarely myopathy, anorexia, peripheral neuropathy, psychiatric disturbances, alopecia, and Stevens - Johnson's syndrome (Reference, Sri Lanka Mims Annual 2001/2002). Physicians who follow - up hyperlipidaemia patients come across above side effects from time to time. The debate about the role of serum cholesterol in the development of coronary artery disease in the elderly is still ongoing. Cholesterol metabolism undergoes several hormone - medicated and liver -related changes that occur with aging. The decision to embark on medical therapy and the aggressiveness of that therapy cannot solely be based on recommendations of National Cholesterol Education Programme but rather needs to individualize to fit each persons situation. According to Dr. Guy Cohen MD, Associate Professor of Family and Preventive Medicine and Psychiatry at the University of California, elderly patients without heart disease suffering from hyperlipidaemia should be tried on low cholesterol low fat diet, exercise and life - style changes first. Elderly heart patients should be treated on an individual basis to prevent mortality due to cholesterol lowering drugs. "Elderly patients (those over 70 years) are more sensitive to medications than young and middle aged patients and elderly patients often accumulate greater quantities of medication in their blood" says Dr. Cohen. Common sense therefore dictates that these elderly patients should be started with lower doses of lipid lowering drugs if there are good indications for statins. Unfortunately common sense has no place in modern medicine. According to Honolulu Heart Programme (Irwin J. Schatz et atl. Lancet, Volume 358, August 4, 2001) there is no justification for lowering cholesterol to concentrations below 4.5 mmol/L in the elderly. They followed up 3741 men over the age of 70 for 20 years and found that there was increased mortality in elderly people with low cholesterol. It was found that persistence of low cholesterol concentrations in the elderly actually increases the risk of death and earlier the cholesterol concentrations are brought down to normal concentrations, the greater the risk of death and those individuals with low cholesterol maintained over 20 year period had the highest mortality. So physicians have to be very careful when they treat elderly people with high cholesterol as cholesterol metabolism and homoeostatic mechanisms differ in the elderly. According to Dr. Stephen H. Hulley of University of California, San Francisco, persons 70 years old and above don't have to shun cholesterol laden food. According to Dr. Stephen, cholesterol levels which predict heart disease in the middle aged people appear to have no such predictive value in the elderly. So you septuagenarians can enjoy this Christmas season by eating to your hearts' content. However moderation is always a good rule to follow. Since there is no evidence that lowering cholesterol helps people over 70 years, doctors should not even take cholesterol measurements in the elderly but otherwise healthy patients. We actually don't know whether elderly people are better off with high cholesterol or low cholesterol. Dr. Basil Rifkind of US National Heart, Lung and Blood Institute says, as people grow older, the relationship between cholesterol levels and heart disease risk gradually weakens. So what should you do for next Christmas? Stick to your low cholesterol or greasy food you miss. If you are over 70, and otherwise healthy you may take ham and bacon if you are dying to taste them, but don't be a glutton. Eat them in moderation so that you will love to eat them again another day. Excess of anything is always bad but moderation never hurts anybody. We also had this letter from a reader in Nugegoda who describes himself as a poor patient on the same subject. See the letter box Oral cancer screening programme for estate population Oral cancer is the most common type of cancer in Sri Lanka. Statistics of the Cancer Institute, Maharagama, the only exclusive hospital in Sri Lanka for this malignant disease show that 25 per cent to 30 per cent of all cancers affecting the population of Sri Lanka are oral cancers. The vast majority of the patients who become afflicted by oral cancer are from the less educated, and economically poor section of the rural population of the country. As in India and other South Asian countries with high incidence of oral cancer, the habits of chewing betel quid with tobacco and arecanut and smoking beedi are highly prevalent in Sri Lanka. The disease is age-related and seen in the 40-70 age group. Pre-cancer lesions and conditions may be seen in younger individuals. Most patients with oral cancer in Sri Lanka present themselves for treatment only after the disease has advanced considerably. In most cases surgical reconstruction is the method of treatment and require highly trained manpower and considerable financial and material recourses. All this means one think prevention and early detection of oral cancer should receive a high priority. Rotary Club of Kandy initiated oral cancer screening and prevention programme with the help of Faculty of Dental Sciences, University of Peradeniya. A mobile dental unit has been donated to the Faculty of Dental Sciences by the Rotary Club of Kandy to carry-out the oral cancer screening and prevention programme in Central Province. This project was funded by Rotary Clubs in Sri Lanka and UK with the support of the Rotary Foundation in USA. A team of consultants and highly trained dental surgeons from Peradeniya Dental Hospital and other volunteers visited nearly 75 estates in Central Province and carried out this humanitarian service to the estate population who are a high risk group for oral cancer in Sri Lanka. This is an ongoing programme and is supported by Plantation Housing and Social Welfare Trust and other NGOs in Kandy. A team of doctors; Dr. A. Ariyawardena, senior lecturer, Department of Oral Medicine, Peradeniya Dental Hospital, Dr. V. Vijayakumaran (Peradeniya Dental Hospital), Dr. Abushaeed and other volunteers visited Kaleebookka Estate in Patha Dumbara division in Kandy district and carried out a dental health camp and oral cancer screening programme on 27th October 2002. The screening programme was done by Dr. A. Ariyawardena and Dr. M. M. Abushaeed. Oral cancer prevention and health education programme was done by Dr. V. Vijayakumaran. The purpose of this programme is early detection and prevention of oral cancer in Sri Lankan population. This programme was coordinated by Dr. Vijayakumaran and sponsored by
Kandy Plan International. Health Watch Letter Box Kadju and cholesterol R. Wickremasinghe from Nugegoda writes In a recent note published in your journal Dr. D. P. Athukorala had said in no uncertain terms that in order to increase HDL (good cholesterol) heart patients should eat Kadju nut and avocado fruit. I do not know on what basis he had come to this conclusion, against all previous advice by all doctors who advise all patients ro refrain from eating any of them as they contain a lot of fat (though non animal). I am a heart patient who attens the cardiac unit of the general hospital regularly. I inquired from the doctors there about this matter, and they vehemently objected to my eating kadju nut, avocado or coconut oil. Now here is one senior specialist doctor (D.P. Athukorala) who encourages the eating of these controversial foods without any reservations (even to say that they increase HDL) as against hundreds of other doctors who advise not to do so. Something is wrong somewhere. It is time that the medical council meet, and have a detailed discussion on this subject and arrive at a final decision in order to put the mind of the public at rest once and for all, as this controversy has dragged on far too long. Dr. Athukorala replies May I refer you Mr. Wickremasinghe what has been published in the Readers Digest of November 2002 on Page 17 - Crazy About Nuts. I wish to quote you the last para in the short article which states - "Why are nuts so heart healthy? It may be because they are high in unsaturated fats; magnesium and Vitamin E. Munching nuts may also help protect against dementia. In a recent study from the Rush Institute in Chicago, USA scientists found that people with a diet rich in foods containing vitamin E were less likely to develop Alzheimer's disease". Please read the whole article. *** High cost of falling ill Dr. Sarath Paranavithane in his letter to Health Watch (Nov. 1st) says statins are "not outrageously expensive". Osu Sala sells Atovastatin at Rs.24.22 per tablet, so for 30 days at the rate of one tablet per day, it would cost the patient Rs.726.60! He says "a statin a day would keep the doctor away". But the patient is more likely to get a heart attack for in a particular hospital in Nugegoda, for each consultation even for a minor ailment a sum of Rs.200 is charged by the doctor who is not a specialist. Many tests are also recommended unnecessarily and the patient has to pay through his nose. No concession is made for elderly patients. However Health Line in Peters' place, Nugegoda gives a discount for Xrays, blood tests etc of all elderly patients. If other dispensaries also follow suit the cost of falling ill will certainly not be "outrageously expensive." A Poor Patient |
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