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Italian medical study reveals : 

Rosary recitation linked to heart health

A medical study done by the Pavia University in Italy has revealed that reciting the rosary is synchronised with the natural heart beat of humans, and thus it renders a beneficial effect on heart health.

The study which has been done by Dr. Luciano Bernardi Associate Professor of Internal Medicine of the University has been published in the British Medical Journal issue 0800, where it states - "The rosary may have partly evolved because it synchronised with the body's natural heart rhythms and thus gave a feeling of well-being and perhaps an increase responsiveness to the religious message too.

The study has also revealed that reciting yoga mantras also have a similar effect.

The BMJ report on the study reads:

Reciting the rosary prayer or yoga mantras enhance some aspect of heart and lung function and might be viewed as a health practice as well as a religious practice, finds a study in this week's Christmas issue of the BMJ. Luciano Bernardi and colleagues recorded breathing rates in 23 healthy adults during normal talking, during recitation of the Ave Maria and yoga mantras, and during six minutes of controlled breathing.

Normal talking reduced the breathing rate more irregularly. Breathing was markedly more regular during controlled breathing, the Ave Maria, and the mantra. Both the Ave Maria and the mantra slowed breathing to around six breaths per minute, inducing a favourable effect on the heart's rhythm.

The benefits of breathing exercises in the practice of yoga have long been reported, and mantras may have evolved as a simple device to slow respiration, improve concentration, and induce calm. Similarly, the rosary may have partly evolved because it synchronised with the body's natural heart rhythms, and thus gave a feeling of well-being, and perhaps an increase responsiveness to the religious message.

(We thank Dr. Dennis J. Aloysius of the Health Watch Medical Advisory Panel for sending the BMJ report on the study for use in the page today.

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Cashew, avocado and heart patients

This refers to the article which appeared on 13th December 2002 under the caption, "Cashew, avocado and heart patients": a reply by Dr. Damayanthi Perera.

First and foremost I must thank the "Health Watch" of Daily News for the valuable service it is rendering to the community by obtaining the services through advice and counsel from eminent physicians / surgeons / cardiologists and various medical and other specialists.

I am a retired government pensioner and people like me, I am sure have benefited from these columns. Secondly Dr. D. P. Athukorale is an eminent cardiologist who has rendered great service to the Sri Lankan community for well over 35 years, and has been one of the pioneers who has made a concerted effort to educate the public in prevention of heart disease in Sri Lanka.

She writes, "I have been monitoring what appears in the mass media in relation to nutrition for some time." Does she know that there have been various articles even in foreign magazines on food/diet, that have a bearing on health and prevention of certain diseases? Even mass circulation magazines and weeklies such as Readers Digest, Time and Newsweek sometimes give columns on health and diet by eminent doctors and medical scientists. Such articles are also not individualised - giving each persons 'weight' and diagnosed health state.

These are generalised articles for the reading public for their general knowledge. Dr. Damayanthi Perera could have seen in Health Watch column of 13th December 2002, where Dr. Athukorale has replied an individual question of a patient, after general advice, he has referred the patient in question to go back to his family physician - "Please see "Soluble aspirin and prevention of heart attacks and strokes". I have seen many such instances in the Health Watch even in previous publications.

Dr. Damayanthi Perera also goes on to write that "there have been a spate of articles on nutrition related subjects such as tea, rice, coconut, meat eating, vegetarianism and protein". So what? Does not Dr. Damayanthi Perera know that so much of research has been done on these items of food and beverage? There have been so many articles in various foreign magazines. Knowledge is also available in the internet. Is it bad for Dr. Athukorale or any other physician for that matter to write in Sri Lankan papers for the benefit of the community, particularly, for those who have no access to internet or other foreign sources?

I do not know how many nutritionists there are in this country. Perhaps ten to fifteen? Can these nutritionists deal with 19m. population to give individualised nutritional advice, checking everyone's health state, 'weight' etc.? A family physician or medical doctor in the best available guide to give counsel on nutritional advice to a patient under his care. I presume if considered necessary only, the physician may refer the patient to a nutritionist/dietician. (I am only a layman. I have never been referred to a nutritionist by my family physician). I believe a nutritionist should not and is not qualified to treat or advise a patient on his or her own right. It is best that we learn 'to render unto Caesar what is Caesar's.

Tilak Ponnamperuma, M. Ponnamperuma

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Acupuncture effective for Osteoarthritis - WHO

Needle your joints: Both the United Nations World Health Organisation (55) and an expert panel of the National Institutes of Health (56) (NIH) consider acupuncture effective for treating osteoarthritis. The NIH panel analysed six studies. Five showed that compared with placebo treatment, acupuncture produced significant improvement (57). Here's a sampling:

At the University of Maryland, Dr. Hochberg prescribed mainstream treatment for 58 people with osteoarthritis of the knee. Half also received acupuncture (two sessions a week for eight weeks). The standard-treatment group experienced no improvement, but those receiving acupuncture reported significantly less pain and disability. (58)

Danish researchers divided 29 people awaiting surgery for a total of 42 arthritic knees into two groups. One received acupuncture; the other, no treatment. After six months, the acupuncture group had significantly less pain, and greater range of motion. Then the control group began receiving acupuncture. Six months later, compared with baseline, the participants reported 80 per cent relief of knee stiffness. Seven participants responded so well that they no longer needed surgery, saving $9,000 (U.S.) per operation. (59).

Points used depend on the affected joints. Acupuncturists often needle the opposite joint. If your right knee is the problem, they may needle your left to move chi (life force) from the healthy part to the weak part. Sri Lanka's only acupuncture clinic is at the Colombo South Teaching Hospital, Kalubowila, headed by Prof. Anton Jayasuriya.

Hundreds of patients daily come to this clinic for treatment, where foreign Alternative Medicine doctors are also in attendance. Some of them have come here to specialise in certain aspect of acupuncture. Treatment is free.

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Some misconceptions about atherosclerosis

by Dr. D. P. Atukorale

Misconception 1

Atherosclerosis (hardening of arteries) is a natural physiological consequence of ageing. This is not true. Many people have the mistaken idea, that as one gets older, one's arteries harden, as through, after a limited number of years, the artery's inherited destiny is to become rigid, blocked and inflexible. This is not so. Hardening of the arteries while prevalent in the elderly, is the result of metabolic changes that actually start early in life.

Misconception 2

Breathing difficulties, chest pains or leg cramps are most often associated with atherosclerosis. Above statement is not true. You can have advanced atherosclerosis without the above symptoms. On the other hand you can have chest pain and not have heart disease. While exertion related chest pain, leg cramps (claudication pain) or shortness of breath are common symptom of atherosclerosis and coronary artery disease, many other conditions can cause these symptoms.

Gall-bladder disease, hiatus hernia, and shingles are three ailments in which pain can be remarkably similar to that of heart disease. Cardiospasm resulting from irritation to the lower end of oesophagu's is sometimes hard to distinguish from angina.

Chest pain can stem from inflammation of the pleura or rib cartilage or from arthritis in the joints between the ribs and the spine 'or sternum.

Less usual but still worth mentioning are chest pains resulting from unsuspected broken ribs brought on by a bout of coughing, sleeping with arms and shoulders in an unnatural position or excessive air swallowing (aerophagia) also cause chest pains. Hyperventilation may produce symptoms similar to those of serious heart disease.

Then there are some people especially the diabetic and the elderly patients who have experienced unsuspected silent heart attacks (i.e. myocardial infarction without getting the typical chest pain). Therefore when you become nervous about your cardiac functioning, do not assume it is due to heart disease or that is not, but see your family physician or go to the nearest hospital and get admitted if advised by the admitting officer.

Misconception 3

The cause of heart attacks is always blocked circulation caused by an atherosclerotic plaque This is false. The degree of arterial blockage has never been correlated with either heart attacks or symptoms of coronary artery disease, although mechanical blockage of the arteries is one important factor.

Heart attacks may be triggered either by a mechanical blockage (a clot, or a plaque rupture or embolism) that causes complete cutoff of the blood supply to the portion of heart muscle or by coronary artery spasm which can cause sudden blood stoppage or by both or by both events occurring simultaneously, with spasm superimposed on a pre-existing plaque.

In both events, malfunction of the heart results from compromised blood flow and reduced oxygen supply causing heart muscle cell death (myocardial infarction) which can cause severe angina, or dangerous arrhythmia (palpitations), heart failure, shock or cardiac arrest. Sometimes cardiologists come across patients who get heart attacks with perfectly normal coronary arteries. Conversely there have been many published reports of individuals with blockage of all three main coronary arteries but had no abnormal cardiac symptoms (such as angina) with excellent exercise tolerance to strenuous physical exertion.

When three astronauts perished with the tragic Project Apollo launch pad fire on January 27, 1967, postmortem examination revealed that all three of these men in "superb health" showed signs of severe atherosclerosis. One of them had very advanced atherosclerosis of all 3 major coronary arteries although he was running more than 10 miles daily and passing semi-annual astronaut physical examinations.

Misconception Number 4

Low cholesterol diets reduce the risk of atherosclerosis.

It is common knowledge that cholesterol is necessary for many vital functions of our body such as (a) emulsification, digestion and absorption of fats, (b) synthesis of sex hormones (c) production of vitamin D via an interaction with sunlight on the skin, and (d) antioxidant protection of the lipid membrane surrounding every cell.

Cholesterol not only enters as food but is predominantly manufactured internally by the liver and other organs. Two thirds of our body's cholesterol is produced by the body's own cells and does not come from dietary cholesterol intake. Much of the cholesterol deposited in the atherosclerotic plaque is produced within the body and is not produced from food cholesterol. Some of the cholesterol is produced within the plaque itself. What is not widely known is that cholesterol is harmless if the cholesterol is not oxidized. Only oxidized cholesterol is harmful.

The dietary recommendation to take a low cholesterol diet for people with high blood cholesterol may be somewhat beneficial because the low cholesterol diet will usually result in less total fat consumption. It is the low saturated fatty acids you get in low cholesterol diet that help you to prevent heart disease.

Fats are easily oxidized and in excess can overwhelm the body's antioxidant defences. Many foods consumed in food are already oxidized in the cooking process and thus speed the release of oxygen radicals in the body.

It is not the cholesterol per se that is the culprit. People suffering from high blood cholesterol are endangering their health by eating too much of fat not from eating too many high cholesterol items.

Diets that contain low saturated fats (and not necessarily low cholesterol) reduces the risk of fat atherosclerosis.

Misconception No. 5

Vigorous sports and physical activity will protect one from developing atherosclerosis.

Postmortem examinations performed on highly active people including marathon runners have disclosed far advanced atherosclerosis with extensive arterial plaque build-up although these people rarely exhibited symptoms of disease.

Investigations of highly mobile populations such as the nomadic members of Masaic tribes in Africa who routinely walk between 20 and 30 miles per day have been found to have surprisingly high incidence of atherosclerosis. The Masai diet is high in peroxidized and oxidized cholesterol. That is not to suggest that regular exercise is without benefit. The physical activity of Masai good example of the protective effect of exercise. Like other super active people, Masai while not immune to plaque build-up, rarely suffer symptoms of arterial blockage while not immune to plaque build-up, rarely suffer symptoms of arterial blockage from this condition. Exercise promotes collateral circulation around the blocked arteries and causes compensatory enlargement of the plaque filled arteries.

Exercise has not been proved to stop plaque formation. But exercises improve the serum HDL (friendly cholesterol) level. HDL is the unoxidized portion and has a retarding effect on development of atherosclerosis. People who take regular exercises have less sudden deaths from coronary disease in spite of having extensive arterial plaques. They feel better, with more energy, increased mental alertness and less depression.

It was found that bus drivers who sat all the day had much higher heart attack rate than did bus conductors working in double decker buses. Exercise does help to protect you from harmful effects of atherosclerosis, but it does not prevent development of atherosclerosis.

Misconception No. 6

Consumption of margarine is an effective way to prevent atherosclerosis

Margarine manufacturers have successfully popularized a massive public misconception that consumption of margarine especially the so-called polyunsaturated margarine prevent heart attacks in people with high blood cholesterol. One study even showed an increase of heart disease among people who used margarine on a regular basis. All solid margarines have significant amounts of trans-fatty acids which increase atherosclerosis. In some of the more developed countries, manufacturers of margarine have to state the amount of trans-fats in the margarine label. Transfat although they are theoretically unsaturated fats, are hydrogenated fats. All hydrogenated fats are bad fats and raise your level of LDL (atherogenic cholesterol) and bring down the level of HDL (friendly cholesterol). Solid margarine have significant amount of tras-fats. The Government must pass laws to force margarine manufacturers to state the amount of transfats in their products as in other countries.

Misconception No.7

Hardening of arteries begins with build-up of Calcium deposits to form plaques

The initial in arterial disease is damage to the inner linning (endothelium) of the artery resulting from blood flow stress, routine wear and tear or free radical damage. The arterial wall cells mutate in response to free radical damage to the genes contained in the nucleus. The tumour (atheroma) is an unwelcome space occupying mass on the inside of the artery which accumulates collagen, elastin, and other connective tissue constituents eventually, growing to block the flow of blood.

When this growth exceeds its blood supply of oxygen and nutrition, it begins to break down in the centre becoming decayed and necrotic and gradually gather deposits of cholesterol and calcium. As it grows into what we call a plaque it becomes progressively firm and more rigid and calcified. Calcification is a late occurrence in plaque formation and not the initial event.

Courtesy 'Bypassing Bypass Surgery' by Elmer M. Cranton M.D.

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Advice on Nutrition

Dr. K. N. K. Wijewardena, former Deputy Director, Colombo National Hospital referring to Dr. Mrs. Damayanthi Perera's articles last week in this page on nutrition states -"

'I make it a point to read the Health Watch as there is very useful information in it, on health and related matters.

I do not wish to enter into any controversy about nutrition, but I must raise strong objection to Dr. Mrs. Damayanthi Perera (DP) stating that only persons qualified in nutrition can advise the public (including patients) on diet and nutrition.

There is nothing sacroscant about nutrition and all doctors have done biochemistry and if they take the trouble to read journals and other related articles they are eminently qualified to give general advice on diet and nutrition to anybody.

What Dr. Atukorale has been doing was giving dietary advice to heart patients aimed at preventing heart disease.

He was not talking about obesity which is usually associated with diabetes and heart diseases.

I do not think (Dr. A.) advised anybody to eat cashew or avocado ad lib. We all know that too much of anything is bad. We were taught in Medical College that drinking water in excess can cause water intoxication, and that too much of even tea at one sitting can be fatal. Everything has to be done in moderation.

I would like to draw the attention of (Dr. D.P.) to the poor physical stature of our younger generation and ask (since she is the Ministry Consultant on Nutrition) what steps the Ministry is taking to arrest this trend? Fast bowlers in cricket

Sri Lanka has difficulty in finding fast bowlers in cricket due to poor nutrition of the people, resulting in growth retardation of the children.

Pakistan

Pakistan has a good consumption of milk, wheat, mutton and therefore has no difficulty in finding tall sportsmen.

Not only genetics

In Sri Lanka poor height of the people cannot be attributed to genetics, as sportsmen of the previous generation were mostly well built and tall.

Paying the strikers

Dr. (D.P.) has spoken about heavy health expenditure. No doubt with all these wildcat strikes going on in the health sector and the state paying the strikers even for the period they struck.

Another view

Dr. Mrs. Damayanthi Perera is right - (Dr. Eugene Corea of the SLMA)

Dr. Eugene Corea of the SLMA in a statement to the Health Watch on the same issue relating to Dr. Mrs. Damayanthi Perera's article on nutrition said.

She is right

I think she is right when she says that only qualified nutritionists should give advice on nutrition to the public specially through the media on controversial issues, like eating cashewnuts and avocado.

In this country ordinary people generally tend to believe whatever a medical specialist says on health and related matters, without any question. This is why medical specialists have to be careful not to talk in public or give advice specially through the media in areas where they are not specialised. This does not mean that they have no right to talk to a patient individually on such a subject in general.

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Health Watch Question box

A patient requests

I. L. Borange from Maharagama Tel. 840756 wants Asoka Weerakoon from Kandy who wrote to the Health Watch last week about a cheap alternative medicine for high cholesterol to contact him. As he too finds it difficult to cope with high cost western drugs for this condition. Since Mr. Weerakoon has not given his complete address nor the telephone number, we thought to publishing this short note - Health Watch.

On Marmite - diabetes and hypertension

Q: Asoka Weerakoon from Kandy raises the question - "Is there a possibility of a diabetic patient developing hypertension by taking a daily cup of Marmite?

Dr. Atukorale replies:

Not at all. No there is no possibility of a diabetic patient developing hypertension by taking a daily cup of Marmite.

Has anyone that you know of complained of a thing like that. Because it just cannot happen for the reason that Marmite is said to contain yeast extract.

Vegetable extract B complex vitamins, such as nicotine vitamins B1, B2 and folic acid and vitamin B 12, taking a daily cup is very useful to vegetarians, who don't get sufficient vitamin B 12, as vegans do not take milk and milk products. Folic acid contained in Marmite will be useful to all heart patients and all those who have coronary risk factors. Consumption of folic acid daily prevents heart attacks by reducing the blood homocysterine level.

Reduction of homocysterine level reduces the stroke rate by 19 per cent if you take folic acid daily. Not only Marmite, even beans and green vegetables have significant amounts of folic acid (Dr. Robert Clerk in time November. 18, 2002 issue).

Problem of gas

Q: Akram Marikkar from Colombo writes

I am a 17 year old student and I read "Health Watch" with interest. Your advice has greatly impressed me.

I have a problem of severe gas in the stomach. This problem occurs on and off, especially when I eat spicy food.

Dr. Atukorale's reply:

As your flatulence (gas in the stomach) occurs when you consume spicy food, it is advisable for you to avoid the consumption of spicy food as much as possible. As you have found by trial and error that taking gaviscon syrup helps your flatulence, and taking syrup gaviscon once in a way does not cause any ill effects, take 10 ml of gaviscon whenever you get flatulence. You should avoid too much of chillies, spices, pickles, tomatoes, pineapples, and pepper as you may be suffering from hyperacidity. Aspirin and NSAIDS such as diclofence, and ibupfofen are best avoided.

As flatulence is a gastro-enterological problem you should see a physician with special interest in gastro-enterology or a gastro-enterologist and get yourself fully investigated and follow his or her advice. My gastro-enterology knowledge is limited to what I studied before 1969.

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Risk perception

The World Health Organisation - WHO issued its report on World Health 2002 last week.

The first copy of the Report was handed over to Health Nutrition and Welfare Minister P. Dayaratne by the WHO Representative in Sri Lanka by Dr. Kan Tun.

In this report in the chapter on 'Risk Perception' in page 31 it states -

"There is wisdom as well as error in public attitudes and perceptions. Lay people sometimes lack certain information about hazards. However, their basic conceptualisation of risk is much richer than that of experts and reflects legitimate concerns that are typically omitted from expert risk assessments.

As a result risk communication and risk management efforts are destined to fail unless they are structured as a two way process. Each side, expert and public has something valid to contribute each side must respect the insights and intelligence of the other".

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