Is married life a contributory factor for diabetes in men?

Diabetes and the Diet: The question arose on Saturday April 1st, at HealthWatch's Health quest question based health education talks on Diabetes and the Diet held at the National Diabetes Centre at Rajagiriya, when the speaker Dr. Mrs. Renuka Jayatissa, Consultant Nutritionist Medical Research Institute, Colombo detailing out causes for diabetes said "It has now been established that leaving all other causes out stress in life alone can cause diabetes in a person".

This gave rise to a lively and entertaining exchange of views from the audience with Dr. Renuka and the other doctors present on stage.

The view was expressed that since most of the stresses for men come after marriage it is worth investigating the incidence of diabetes among bachelors due to the stress factor, so that a conclusion could be drawn whether marriage could be a contributory factor to diabetes in men.

The view was also expre, in marriage, the stress factor could not be affecting them so much. One member in the audience jokingly said that the stress factor was so much in his married life, that he had filed divorce papers. Doctors adviced him "don't do that" because you are only adding to marriage stresses with legal stresses as well.

I fully agree, he said, I am going to withdraw the case and carry on with life! Another member had this to say. "A stress free worldly life is impossible to have. Life is incomplete without a wife.

So better to have a complete life with a wife to share and bear the stresses.

Following this interesting dialogue on marriage and stress we have decided to organise the next Health Quest talk on coping with stresses in life - Healthwatch.

Dr. Renuka stressed the following points to keep out and cope with Diabetes

* Keep to a balanced diet, with adequate exercise, with one hour of walking a day at least.

* Ensure that you have a good breakfast. Rice is best, or bread, or whatever madeout of rice flour.

* Drink plenty of water.

* Parboiled rice is the best for diabetics, but it should be of good quality.

* Eat everything in moderation.

* There is no harm in eating even icecream and puddings after a meal, but not much.

* One can have a little sugar even, about 5 to 6 grams a day, one teaspoon.

* We have about fifteen varieties of plantains in this country. Any of these varieties could be eaten, but not exceeding two fruits a day.

In the case of 'anamalu' and 'ammung' half a fruit a day.

* Overripe fruits are to be avoided, as the sugar content is more in them.

* Diabetic jam better avoid she said, because it is diabetic, one tends to eat more of it, spreading lavishly on bread, resulting in adding more calories to your system, which is not good.

comprehensive account later

A comprehensive account of what she recommended will be carried later in this page.

Magnitude of the problem in Sri Lanka

Sri Lanka is no exception from the growing problem of diabetes. Recent studies on its prevalence in our country have shown that it exists in the proportion of 12-14% in the urban adult and 7-8% in the rural sector with a reservoir of impaired glucose tolerance in excess of 10%; totalling a prevalence of abnormal glucose tolerance at around 22%. Is Good Life a cause for diabetes?

The internal migrations between rural and urban sectors further complicate the issue and the highest percentage is in the foreign migrant worker, being twice the figure quoted for the indigenous population.

The problem we are faced with is the rapid urbanization of the village without the physical migration, by virtue of the transfer of a large quantum of refined foods and the increased availability of mechanized transport, both of which tend to lead to rapid weight gain and T2DM.

These figures envisage that we are in a rapidly changing environment where the desire for 'good life' is making this illness more prevalently than ever before. This is very evident when comparing with earlier studies carried out 10-15 years ago, which showed a prevalence of T2DM at 5% in the urban and 2% in rural sector.

Aetiology of T2DM

The aetiology of this disease is multifactorial, and for a long period of time the global medical fraternity did not uniformly accept a consensus on all the important factors in its causation. This prevented a development of a comprehensive preventive package.

In 2002, the Diabetes Association of Sri Lanka together with the International Diabetes Federation (IDF) and WHO spearheaded a dedicated meeting in Sri Lanka to comprehensively study and develop a consensus in the presence of 350 foreign and local scientists.

A unanimous consensus was reached at the conclusion of this meeting, which was a landmark event in our recent history of Diabetes. The factors agreed upon were as follows: Genetics, fetal origins, lifestyle, stress.

Based on the above, it was decided that primary prevention should be addressed as an urgent need on a global basis by each country developing its own strategy taking into consideration local needs and issues.

HealthWatch gets recognition in Singapore

Two way benifit flow to readers

MORE PRIzES: Singapore's Parkway Healthcare Group which has three leading Hospitals in the private sector under its management, the East Shore Hospital, Gleneagles Hospital, and Mount Elizabeth Hospital and nine other hospitals in the region including Malaysia, Indonesia, Brunai, UK and India with 1200 specialists working in them, has written to HealthWatch offering the services of its specialists to advice the Daily News readership on any of the health problems they have through a question-answer column in the HealthWatch starting from May.

Consolation prizes to the medical crossword

The Singapore Parkway Healthcare Group is also offering three consolation prizes in cash to the Medical Crossword from crossword No. 20 which is to be drawn shortly. The Hospital Groups Marketing Manager for South Asia David Chen in his letter to the Daily News says:

"Daily News being one of the most popular newspapers in Sri Lanka, and its medical page HealthWatch being the most popular health page in the country's English media newspapers, we are seeking to be of service to its readership and the country's public at large, through these two areas in the page we are seeking to sponsor"

We wish to inform our readers that we accepted these two offers, and details regarding its operation will be published next week.

- HealthWatch

More than one third of Sri Lankans die annually of Ischaemic Heart Disease

- Prof. Rezvi Sheriff

Delivering the Al Haj Dr. A. M. A. Azeez commemoration speech held in Colombo recently Al Haj Prof. Rezvi Sheriff said;

Spiritual health: Ischaemic heart disease (heart attack) is the cause of death of more than one third of Sri Lankans. Five major risk factors of ischaemic heart disease are Diabetes mellitus, high blood pressure, hyperlipidaemia (high blood cholesterol), cigarette smoking and heredity.

Except the last, all other four major risk factors are avoidable, preventable or controllable. Each risk factor has its own percentage of predisposing risk. Obesity is one of the main reasons for diabetes mellitus and hyperlipidaemia which are assuming epidemic proportions today.

Lack of exercise and faulty eating habits are the main causes of obesity. Central obesity (abdominal) has higher risk of causing heart disease than generalised obesity. Lack of exercise and mental stress are the main reasons for high blood pressure.

Because of the strong association, these diseases have with the mind, these diseases are called psychosomatic diseases. Physical health of a man depends considerably on mental health.

Even immunity against infections and cancer is influenced by mental well-being. Recent research has shown that mental stress of a pregnant woman affects adversely even the growing baby in her uterus. Mental health is largely influenced by spiritual health. So we can see that physical, mental and spiritual health are strongly inter dependant and inter related.

To have a turning point with strong positive impact on the health of Sri Lankan Muslims, it is needed to educate the community on physical, mental and spiritual aspect of health, in a proper, sufficient and effective way. Hereditary predisposition cannot be changed. Smoking, in addition to alcohol, which is an important cause of obesity in other ethnic groups, are forbidden according to Islamic Shariah (Law).

Regular exercise, healthy food habits and meditation can prevent or control these diseases to a greater extent. As Muslims, strict adherence to Islamic values can contribute tremendously towards this end.

Attending to five times obligatory prayers at the mosque with complete submission to Almighty Allah (Ihlas) involves great measure of regular exercise and Meditation.

Weight management is very important to have a healthy life. One should maintain ideal Body Mass Index (BMI) which is calculated from height and weight. To cut down the excess fat (weight), energy intake should be lower and energy expenditure should be higher.

This has to be achieved by changing from sedentary lifestyle to physically active lifestyle with regular exercises and good dietary discipline. Walking briskly, cycling and swimming are the best exercises which have to be done at least for 30 minutes a day for six days a week.

Exercise and meditation reduces a person's susceptibility to mental stress and increases the person's ability to develop a mind set with strong will-power, emotional stability and self control. Consequently he would be able to avoid over indulgence in foods.

Good food habit involves choosing the healthy foods and avoiding or reducing unhealthy foods. Pork which has very high amount of fat (cholesterol) is fortunately forbidden in Islam. Traditional foods are better than modern processed and fast foods.

Overweight people should avoid all energy dense foods such as sweet foods and drinks, fried and oily foods, processed foods and fast foods.

They should take fibre containing (low glycaemic index) foods such as vegetables, fruits, pulses, peas and grams instead of refined foods.

Red rice, atta flour and kurakkan flour are better than polished rice and wheat flour.

Beef, mutton and egg yolk should be avoided or limited to the minimum.

Curry chicken is better than broiler chicken. Unsaturated fats and oil should be taken instead of saturated fats. Sun flower oil, Corn oil, Soya oil, Gingelly oil and Canola oil are better than coconut oil and palm oil.

Non fat milk is better than full cream milk.

Malnutrition 'time bomb' warning

Dr. Viraj Peramuna writes:

This study done in UK which to brings out the importance of checking malnutrition on patients seeking treatment, should be an eye opener for us in Sri Lanka too. Hence I am sending it to the Healthwatch for publication.

Europe's ageing population means more will die of malnutrition unless urgent action is taken, warns a charity.

The European Nutrition for Health Alliance says the problem is already endemic in the community, hospitals and homes for the elderly.

Experts believe up to half of elderly people in hospitals and residential and care homes are malnourished.

With the number of 80-year-olds doubling every decade, the number of malnourished people could also grow.

We are facing a time bomb

Professor Jean-Pierre Baeyens, co-chairman of ENHA

The ENHA said care providers needed to do more work on identifying and treating those most at risk.

This includes people who are sick with long-standing diseases as well as the elderly.

The alliance's co-chairman Professor Jean-Pierre Baeyens said: "Malnutrition is indeed endemic. Many people are not aware of the problem. If we do not act now, it could increase. We are facing a time bomb."

Being malnourished is different to being underweight, although they often go hand in hand. It is possible to be overweight yet malnourished.

Malnutrition means not getting enough of the essential nutrients we need for a healthy life.

Not only does it cause health problems itself, it delays recovery from illness.

Professor Marinos Elia, Professor of Clinical Nutrition at Southampton University, estimates that malnutrition and its associated diseases cost the UK 7 billion pounds a year.

Simple solutions

He said there were simple solutions that could help. For example, in Scottish hospitals it is now becoming mandatory to screen patients for malnutrition, he said.

Those who are malnourished may need help with feeding and selecting the right foods or require supplements.

In England, the Government has revamped NHS hospital menus in a bid to make them more appetising for patients.

"There is more recognition but it is still not enough," said Professor Elia.

Professor Peter Kopelman of the Royal College of Physicians said he would like to see malnutrition checks become mandatory in English hospitals.

He said there had been an improvement in the quality of hospital food in recent years but that there were still malnourished patients in hospitals.

He said training healthcare professionals about nutrition was key.

Jonathan Ellis of Help the Aged said many older people needed help to eat meals, yet received no assistance.

"Malnutrition in these cases can so easily be prevented by delivering basic standards of care. To deny such basic care in the 21st century is simply unacceptable."

Effects of Malnutrition

Impaired immune responses

Reduced muscle strength and fatigue

Breathing difficulties

Impaired thermoregulation

Impaired wound healing

Apathy depression and

self-neglect poor libido.

(Courtesy: BBC News)

Questions based on Diabetes and the diet a success

Our first Health Quest Health Education Programme, last Saturday (April 1st) at the National Diabetes Centre Auditorium at Rajagiriya with Dr. Mrs. Renuka Jayatissa (Consultant Nutritionist, The Medical Research Institute (MRI), Colombo) coming on stage to speak on questions based on diabetes and the diet was a grand success agreed many present, as the audience engaged with her in a health absorbing dialogue for over one hour.

At the end of the dialogue, a retired Army Brigadier getting up and said: "On behalf of the audience let me thank the Daily News Medical Page HealthWatch for organising this most health giving talk, where we got some of the doubts on food and diabetic cleared from Dr. Mrs. Renuka.

"While thanking the doctor for this most interesting hour, we had with her we wish to thank the National Diabetes Centre and the Philo Biotics also for the part they have played in this programme. We hope there will be more of these programmes in days to come."

We say thank you too.

HealthWatch, Daily News Editorial with Philo Biotics wish to thank Dr. Mrs. Renuka Jayatissa taking time off her busy schedule of work to participate in the Health Quest first programme.

Dr. Janaka Weeratunga, Medical Director National Diabetes Centre for all the help given for conducting the programme at the NDC, and all those who attended the programme and sent in their questions.

We also wish to congratulate the three readers who sent in the prize winning questions.

Responsible advertising in food products

Dr. Renuka Jayatissa, Consultant Nutritionist, Medical Research Institute, Colombo on Saturday called upon the advertising firms and the business community to do their food promotion campaigns in a more responsible way than at present, where the promotions with regard to most of the items, specially fast foods end up creating health problems to the people.

She was replying a question sent by a reader in Homagama, whether some of the food advertising carried in the media, both print and electronic on fast food items targeting the children aren't health risky?

She said, she fully agreed with the issue raised by the reader because one reason for the fast growing problem of obesity among children which leads to diabetes in their later life is the heavy consumption of fast food items by them, which they see widely advertised in the media, with catchy slogans.

"This is a sad situation we are facing as a result of not having an advisory body yet in the Ministry of Health on food advertising.

"We have drawn the attention of the Ministry for the urgency to set up this body, and we hope it will be done soon," she said.

Dr. Renuka spoke for over one hour from 10.30am to 11.45am, answering diet related questions from the audience and replying some of the written questions sent by the HealthWatch readers.