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by Dr. D. P. Atukorale

With reference to the article on "Cashew, Avocado and heart patients' by Nutrition Consultant Ministry of Health Welfare and Nutrition (to whom I shall hereafter refer as N.C.) entitled "Cashew, Avocado and Heart patients: A reply (D.N., Health Watch 13.12.2002). The above article by N.C. is full of grossly erroneous and misleading statements which N.C. uses to attack me personally by my name. I have reason to suspect that her motive is maliciously to tarnish my image and to induce the readers and my patients to lose confidence in me.

In her article to "Health Watch" N.C. says that she will refer to me as "The Learned Doctor (L.D.)." The general tone of her article and its contents lead one to the inference that she uses the word "Learned" there with some sarcasm as the general tenor of her article seems to show that I am by no means a learned man.

N.C. says that "it is human to err and we are all bound to make mistakes and that she is no exception. She certainly has made many mistakes in her article and I would like to point out some of those errors and inaccurate statements made by N.C. which confirms her own statement that it is possible for her to make mistakes.

N.C. alleges that I have recommended the eating of cashew and avocado "without conditions or ad libitum (without limits). This statement is a falsehood. I have never made such a statement. I have taken the trouble to write a large number of articles on nutrition to Sinhala journals and to both Sinhala and English newspapers during the last few years. In none of these articles on nutrition, I have advised the readers to consume any nutritional item including cashew and avocado "ad libitum" (without limits).

The Health Watch readers are intelligent people and I have never heard of any Sri Lankan who consumes avocado and cashew nuts without limits. No person with an atom of commonsense will do such a foolish thing.

Too much of anything is undoubtedly bad and "even drinking water in excess can cause water intoxication" (Dr. K. N. K. Wijewardena, Health Watch 20.12.2002). I challenge N. C. to quote any article written by me or any other medical doctor which states that any particular food items may be consumed without limits.

N.C. says that I have written an article entitled "Avocado, A solution to Heart Disease (D.N. 30.05.2001). The title I gave to the abovementioned article was "nutritional value of avocado. This title has been altered to "Avocado a solution to heart disease" by someone at the press. Therefore N.C.'s lengthy and pompous exposition starting with the statements "Heart Disease has a multi-factorial aetiology" (which even a junior nurse is aware of) is quite unnecessary.

The same article which I sent to the Sunday Observer appeared in that paper on 24.06.2001 with the caption "Avocado, The Wonder Food". It is customary for subeditors of newspapers when publishing articles to give their own captions which attract the attention of the readers.

N.C. says "I don't want to be harsh on Dr. Atukorale. But most readers of the article will certainly think otherwise.

N. C. says that a nutritionist )dietician) may incorporate foods such as cashew and avocado in limited quantities. This is what I have always been advising the readers. N. C. has stated that my articles are "factually incorrect and misleading and nutritionally incorrect". But N.C. has not quoted a single instance where I have been wrong. N. C. has failed to point out a single example of "incorrect and misleading and nutritionally incorrect" statements in any of the large number of articles on nutrition I wrote to newspapers and journals.

In all my articles on nutrition, I have cited the latest authoritative information available and I have given the references wherever it is necessary quoting chapter and verse. For example in my article on avocado (D.N. 30.05.2001) I have quoted ten references. This is the established practice when writing articles on scientific or technical subjects. N. C. however makes pompous statements on scientific subjects without citing any authority for her statements. Perhaps the suggestion may be that they are her own original discoveries.

A large number of articles have been written from time to time by doctors, ayurvedic practitioners, journalists and many others. However N. C. has singled me out of all these writers and attacked me personally by name for reasons best known to her.

I have over the years taken the trouble to contribute a large number of articles on nutrition (as I am qualified in nutrition) to three English dailies, four Sunday English newspapers, one English weekly, four Sinhala dailies, five Sunday Sinhala newspapers, and eight Sinhala journals with the sole motive of educating the readers on this subject which interests every person.

I have written articles on the nutritional aspects of cashew nuts, avocado, papaya, peanuts, legumes, dhal (lentils) gingili oil, olive oil, coconut oil, coconut milk, king coconut water, tea, jak fruit, seaweeds, garlic, Soya, rice, vegetarianism, mushrooms, margarine, polyunsaturated oils, essential fatty acids, protein requirements, essential amino-acids, food poisoning, diet in coronary artery disease obesity, complications of excessive meat consumption, free radicals, antioxidants, eggs, chicken, vitamins, salt and many other nutritionally important topics.

However, although there are so many distinguished and respected specialists and family physicians in this country, no one has pointed out any errors in any of my articles or statements I have made. N.C. is the exception and she (whose existence I came to know only after her article in question was published in Health Watch in Daily News) I understand is not a doctor of medicine though her name is published in the said article after the title "Dr." I am made to understand that she has been awarded a Ph D by some University and as such she is of course fully entitled to have the title "Dr." before her name. While there are so many qualified and experienced medial practitioners in our country, it was a Ph. D that has criticized my articles and that too without citing any authorities to justify her allegations.

All my articles on nutrition are based on facts published in reputed international journals such as American Journal of Clinical Nutrition, latest information provided by the American Dietetic Association (A.D.A), text books on nutrition written by medical doctors such as (a) Food and nutrition by Prof. T. W. Wickremanayake (who was my nutrition teacher in medical school) (b) Davidson and Passmore - Human Nutrition and Dietetics (c) Contemporary Nutrition Support Practice (d) Science and Practice of Nutrition Support by Michele et al, and other text books all written by internationally reputed doctors of medicine and not by any nutritionist (dieticians).

The large number of articles I have written on vegetarianism are based on "Guide to Vegetarian Living" by Peter Cox, which is the only encyclopedia on vegetarian nutrition available at present as far as I am aware. Some of the articles on nutrition are based on facts and figures in "Food and Nutrition by Dr. (Mrs.) Kusum Gupta and Dr. L. C. Gupta who hold a world record of writing 77 medical books.

All medical doctors, dieticians and nurses ( who are given lectures on nutrition at nurses' training school) should give advice on nutrition to the patients and the community. In fact, all dieticians who have obtained their MSc in Food and Nutrition in Sri Lanka have been given lectures on nutrition by Prof. T.W. Wickramanayake who is a world authority on nutrition for whom I have the greatest respect.

All medical doctors including all family physicians and consultant specialists give advice on nutrition to their patients. In fact N.C. herself has admitted in her article that it is the cardiology clinic doctors who give advice on nutrition to cardiology clinic patients. During the 23 years I have served in the Institute of Cardiology, National Hospital Sri Lanka (NHSL) dietary advice to in-ward patients was generally given by the nurses.

Extremely rarely did I refer a patient to the N.H.S.L. dietician. Out of over 100,000 patients treated in the Institute of Cardiology, N.H.S.L., I do not think even one hundred patients were referred to the N.H.S.L. dietician during those 23 years.

Our family physicians are experts on nutrition. I contacted a few senior family physicians when writing this reply and all of them said that they have never referred a single case to any dietician.

There are less than 15 dieticians in Sri Lanka. Can this handful of dieticians give individualized advice on nutrition (which N.C. is advocating) to a population of 19 million.

Does N.C. know that at the premier N.H.S.L. Colombo there is only one dietician (who is on duty at hospital only from 8 a.m. to 12 noon) to give dietary advice to over 3000 patients warded at N.H.S.L. Colombo ?

As far back as 1974, I have been writing articles on nutrition to Sinhala and English newspapers and journals. The two books I have written for heart patients and laymen in 1974 and 1975 devote a significant portion of the texts to nutritional advice. More the 10,000 copies of these books (published in two languages) have been distributed free to patients, family physicians and others attending the Institute of Cardiology, N.C. was perhaps a school girl at that time.

Can N.C. name any Sri Lankan dietician who has made a significant contribution in the field of nutrition by writing articles to Sri Lankan newspapers especially Sinhala newspapers (as 70 percent of Sri Lankan don't read English Newspapers and journals) As Mr. Tilak Ponnamperuma in a reply to NC's article has mentioned, even mass circulation magazines such as Reader's Digest, Time and Newsweek sometimes give columns on health and diet by eminent doctors and medical scientists. Such articles are also not individualizes (DN Health Watch 20-12-2002).

The latest and the first booklet written on vegetarian nutrition in Sinhala by me (a copy of which I have sent to N.C. after I read her defamatory article) was highly appreciated by the Hon. Minister of Health, Welfare and Nutrition. I understand that 5,000 copies of this booklet have been received by the Health Ministry a few days ago. 4,000 copies of this booklet have already been distributed free to the people who have asked for it.

Discussion about cashew and avocado at S.L.M.C.

Both N.C. and the Mr. Wickremasinghe mentioned by her in her article appear to be grossly ignorant of the functions of the Sri Lanka Medical Council (S.L.M.C.) Even a third year medical students knows that S.L.M.C. does not meet to discuss nutritional value of cashew and avocado, or similar topics. It is advisable for N.C. to ascertain the functions of the S.L.M.C. before making such silly statements in the mass media.

N.C. says "Nuts or MUFA are not the issue here. The key issue is the unscientific and irresponsible manner in which scientific information has been distorted and disseminated" However N.C. fails to point out a single instance of unscientific information in any of my articles. Nor does she mention any example of "distortion of scientific information in an irresponsible manner".

Dieticians (including N.C. of Allahabad fame) has not made any significant contribution to dissemination of information on nutrition. Major contribution to education in nutrition in Sri Lanka has been made by authorities on nutrition like Prof. T. W. Wickramanayake who is a doctor of medicines, who has written the most comprehensive book on nutrition.

It is the Doctors of Medicine and not Doctors of Philosophy who have made major contributions on nutrition by writing hundreds of articles on nutrition to Sinhala and English newspapers and journals. Doctors of Medicine are more qualified to give advice on nutrition to patients as they have studied nutrition (with all other aspects of human medicine) from the time they were in medical school as nutrition is a part of the medical syllabus in medical school.

N. C. owes an apology to the thousands of readers for misleading them by writing the irresponsible article published in the Daily News Health Watch (13.12.2002)

Lastly N.C. and all other dieticians with or without a Ph D, as well as all heart patients should read Dr. Dean Ornish's (New York Times best seller) "Reversing Heart Disease". Dr. Ornish is a cardiologist and is the official advisor on nutrition to the White House. He was the adviser on nutrition to President Clinton. William C. Roberts MD Editor - in - chief of the American Journal of Cardiology has said "Dr. Ornish is on the right road".

Dr. Ornish has given a large number of recipes for heart patients in his best selling book on nutrition. His research on nutrition has been published in "The Lancet", "Journal of the American Medical Association (JAMA) And" Circulation". Dr. Ornish has shown that people can clean out their coronary arteries by changes in their lifestyle and without any medication or bypass surgery. I have quoted from this epochal book in some of the articles written by me, citing as always I did the relevant authority.

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