Opinion
I have Cholesterol, Doctor!
“I have Cholesterol” is a common complaint, often causing unwarranted stress and anxiety, particularly among young patients.
When a patient begins the consultation with “I have Cholesterol”, my mind immediately goes back several decades in time to our prep school days, when we sang/shouted, in the dining hall,
I scream
You scream,
We all scream
For Ice cream!
Recalling those childhood memories, I go,
You have Cholesterol
I have Cholesterol
We all have Cholesterol!
The response to my lines is gender based.
Females avoid eye contact and retort in a no-nonsense tone, “I mean I have HIGH Cholesterol, doctor! (Translation: I’m not dumb, you silly man!)
Male patients on the other hand go completely silent as though I had pressed the mute button, (Muwa golu Wuva) and stare back wide-eyed. (What they would really like to say is this: “Just stop talking nonsense doctor, and write me a prescription for some tablets!”)
So, is Cholesterol that bad, after all?
If it had been, during evolution, by natural selection, we would have been extinct by now! Or if you believe in a Creator, why would He want to put such bad stuff in our bodies? (Unless of course he had a cunning plan to buy shares in multinational drug companies that produce Cholesterol lowering Drugs!)
As a matter of fact, folks, Cholesterol is an essential requirement for good health.
Every cell in our body has small amounts of cholesterol, and together with other molecules they prevent cell membranes. (The outer lining of a cell) from being leaky. If a cell membrane is leaky, for example, cells called T lymphocytes, (required for our immune response) will swell up and go POP! and that won’t be nice. While plugging these leaky points, Cholesterol helps maintain the integrity and fluidity of cell membranes, so our cells unlike plant cells do not have a cell wall, allowing them to be more flexible and supple.
And guess which part of our body has the most amount of Cholesterol.
“The liver.” did I hear you whisper?
Nope, not the liver, not muscle, not the heart, It’s our BRAIN! As much as one fifth to a quarter of all the cholesterol in our bodies is in the brain. From birth, until adult life, the brain makes its own cholesterol and all through life from then on, there is a slow turnover of cholesterol throughout life. The brain as you know has billions of cells called neurones, which can make its own cholesterol but it is the supporting cells, called glial cells which are more efficient in synthesising cholesterol and the neurones can make use of this. From the neurones electrical impulses pass along fine filament like processes called axons to communicate with other neurones. These axons are covered by sheaths of Myelin rich in cholesterol (much like the insulation in an electrical wire, but interrupted at regular intervals called “Nodes of Ranvier”) and these cholesterol rich myelin sheaths thus enhance the conduction of electrical signals. Neurones communicate with each other at special junctions called synapses, Electrical signals coming along an axon releases chemical transmitters at the synapse which then activate the next neurone to produce a signal and so on. Recently scientists grew neurones in cultures under experimental conditions and noted they were able to form synapses with each other, but hey were pretty laid back and took their time. Then they added cholesterol to the culture medium and Hey Presto! the neurones started developing synapses faster than Hussein Bolt doing a hundred-meter dash!
“So, what’s the big deal?” I hear you mutter.
Well, boys and girls, the more synapses, better is the communication between nerve cells and this is really important for the developing brain to acquire memory and learning skills.
The blood vessels that are in the brain are lined by tight fitting cells ,forming the so called “blood brain barrier” so cholesterol containing molecules in the blood cannot get into the brain and as we noted before, the brain has to make do manufacturing its own cholesterol for its important functions. Or as Mr. Kipling would have said, Blood cholesterol is blood cholesterol and brain cholesterol is brain cholesterol and never the twain shall mix!
Apart from the brain and nervous system, cholesterol has other important roles.
In the skin it is required for the synthesis of Vitamin D.
The liver uses it as the starting brick to manufacture bile salts, needed to emulsify fats that we eat and help its absorption.
The adrenal gland uses it to make hormones, like Aldosterone which regulates the body’s water content, Cortisol to control inflammation and stress and last but not least, (wait for it — wait for it,) sex hormones like Testosterone and Progesterones. (Aha, NOW I have your attention, don’t I?)
So just imagine life without cholesterol, not enough brain synapses, not enough Testosterone; Life would be deadly dull wouldn’t it?
But there’s always a catch isn’t there?
Too much of a good thing is also bad for us. (Story of our lives, wouldn’t you say? Sigh!).
Cholesterol is a waxy stuff, insoluble in water so it has to hitch a ride with proteins to get to different parts of the body. These molecules are the lipoproteins. Fats that we eat containing cholesterol enter the blood stream as tiny particles called chylomicrons, rich in triglycerides, another kind of fat. The body cells use up the triglycerides as they need for energy production and the remaining particles get back to the liver, where they get recycled as more triglycerides, but if liver is in a bad mood, so to speak, it can turn these returning molecules into cholesterol rich Low Density Lipoproteins, (The “bad” cholesterol we all know). Waxy cholesterol can then get deposited on the inside of our blood vessels and over time, narrow them so that vital organs like the brain and heart are deprived of oxygen and other nutrients. From these plaques little bits may break off and get to these vital organs causing strokes, heart attacks and so on. Sometimes, the plaques become the scaffolding for blood clots to form completely blocking off fairly large blood vessels with catastrophic consequences.
If you treat your liver well on the other hand, it will also produce High Density Lipoproteins (the “good ” cholesterol), which is like an empty garbage truck and collects some of the extra cholesterol lying around and transports it back to the liver.
Clearly then, there are times when lowering Cholesterol levels is desirable. There are two main approaches here.
One is called Secondary Prevention. Here, the strategy is to lower cholesterol in individuals who have already suffered consequences of narrowed blood vessels for example a stroke, heart attack or angina. This is aimed at reducing the chances of further events and death. There is strong evidence from robust randomised controlled trials and meta analysis of these trials that this indeed is the case. In addition, from time to time international cardiac societies put out guidelines indicating to what level cholesterol should be lowered for optimal outcomes and your healthcare provider will guide you.
In the case of Primary Prevention, the goal is to reduce the chances of your getting clogged up blood vessels when you haven’t as yet shown any evidence of it. If this was good for everybody, then we could ask the water board to put cholesterol lowering drugs into our drinking water! Not so, since taking cholesterol lowering drugs also has a downside. Once again, International cardiac societies have developed guidelines where your healthcare provider can calculate your chances of getting an adverse event in the next ten years, called the ten-year cardiovascular risk. Calculated on your age, gender, risk factors for cardiovascular disease like smoking, high blood pressure, diabetes, in addition to your cholesterol levels. Generally speaking, if the risk is over ten percent (not Mr. Ten percent!!) then taking drugs gives you more benefits than risks.
Another area of some controversy is whether individuals over 75 years should be taking cholesterol lowering drugs. The trials mentioned above did not have many people in this age group to make firm conclusions but current recommendations suggest the same approach as in younger individuals.
So young people, I hope, won’t behave like one of my niece in her thirties, who sounded flustered when she rang me saying, “Loku Thathi, I had some pain in the back of my shoulder so I got my cholesterol checked and the report says high!” Why she did the test is a mystery in the first place, but being her Loku Thathi I could afford to be a bit rude and using the slang expression I replied, “Hey! just because the report says high, no need to get your knickers in a twist “! (She has not spoken to me since, but you get the message.)
Now, if you have been thinking, as far as cholesterol is concerned, the lower the better, well, you have another think coming!
Epidemiologists followed up two matched populations, the only difference being that one group had normal cholesterol levels, while the other group had low values. Guess what?
The low cholesterol group actually had a higher all-cause mortality. In other words, the lower cholesterol group had a higher chance of dying from any cause (for example, cancers, infections) compared to the normal group.
The million-dollar question then is this: since we are going to die anyway, does it really matter how we die?
When such a doosra is bowled at us, our Prof. of surgery all those years back taught us how to play it with a straight bat, and we answer.
I don’t know
You don’t know
No one knows!
And that, my friends, is that.
NJ (Consultant physician)
Opinion
‘Outpost of Empire’
Review
by Colleen Figg, Editor
and Reviewer – Amazon, New Voices Publishing
“Fernando echoes Macbeth with the line, “There is judgment here.” It captures the question running through the novel: can anyone participate in corruption and remain untouched by it? Beneath this satire is a dark story about power and the danger of believing, that someone else will always pay the price.”
Shavindra Fernando’s Outpost of Empire is a political novel set in the fictional country of Lackadasia. At its heart is a strong idea: an exploration of world politics, terrorism and the ways in which powerful countries manipulate smaller ones. Fernando is clearly writing about political issues that matter deeply to him.
The names immediately establish the book’s satirical character. Lackadasia, Burgherbugaria and the various Klowns suggest a world in which the people and places are exaggerated, but the issues beneath the exaggeration are recognisable. The playful language allows Fernando to approach terrorism, religious conflict and political corruption from an unusual angle.
Henry Stockwell is a central character: an ambassador who arrives in Lackadasia presenting himself as a friend of the country. He believes he understands how power works and treats the country, its politicians and its people as pawns on his personal chessboard. In his arrogance, he never doubts that he controls events rather than being controlled by them. This confidence makes him a compelling figure and in him, we explore the workings of political influence and the potential traps contained therein.
As the story develops, Fernando reveals a political world where causes are adopted when they are useful, people are exploited and discarded, and the truth becomes whatever those in power need it to be. Ordinary people suffer the consequences of decisions made far beyond their reach or knowledge, while those making those decisions continue to justify their actions. Even the people who help keep this world running may not be as important or as safe as they imagine.
Stockwell brings this idea into focus. He recognises corruption in others and willingly takes part in it himself, yet he cannot see that he might also suffer its consequences. Ultimately, he thinks his position will keep him safe. He is intelligent enough to understand the game, but not insightful enough to grasp the limits of his place within it. This blindness gives the novel a strong sense of irony.
The satirical approach gives Fernando room to criticise political hypocrisy without turning the novel into a direct political argument. By using fictional countries and exaggerated names, he creates some distance from specific governments and events while still making the larger targets of the book clear. The humour does not take away from the seriousness of the subject; instead, it makes the cruelty and self-interest beneath the political performance stand out more sharply.
Near the end, Fernando echoes Macbeth with the line, “There is judgment here.” It captures the question running through the novel: can anyone participate in corruption and remain untouched by it? Beneath this satire is a dark story about power and the danger of believing that someone else will always pay the price.
I came away feeling that Outpost of Empire is a valuable and thought-provoking book, particularly in today’s political and social climate. It has a distinctive voice, and the questions it raises about power, responsibility and foreign interference remain relevant far beyond the fictional borders of Lackadasia.
About the Author
Shavindra Fernando has worked as a reporter. He read English & Classics at the University of Peradeniya in Sri Lanka, and took International Relations & Ethnic Politics as a Reuter Fellow at the University of Oxford in England. The Vague Poetess (1999)was his first novel.
Opinion
Speaker’s dilemma
The Opposition, in its wisdom (or perhaps stupidity), has submitted yet another No-Confidence Motion (NCM) against the Speaker of Parliament. Perhaps it hopes to score some brownie points in the eyes of the public, which is hardly indifferent to such developments. Yet, knowing full well that the motion is unlikely to succeed, the exercise may well prove futile — akin to banging one’s head against a solid rock.
Nevertheless, the nearly fifty allegations levelled against the Speaker, whether justified or mere mudslinging, cannot simply be brushed aside. Such allegations may well have a bearing on the individual concerned, particularly where it matters most — his conscience — and few would dispute that possibility.
From a protocol standpoint, the Speaker occupies one of the highest positions in the country, ranking third in the hierarchy of state. He consequently belongs to the uppermost echelons of public life, with acquaintances and associates extending across a wide spectrum of society, including diplomats and other distinguished personalities. Such a position carries with it not merely prestige and privilege, but also an onerous responsibility to uphold the dignity and integrity of the office.
As the guardian of Parliament, the Speaker is expected to maintain standards of conduct, impartiality and discipline that are beyond reproach.
Whether the allegations are justifiable or not may be of little consequence to members of the ruling party, who will undoubtedly defend their colleague to the hilt. Nevertheless, the stigma arising from such allegations may prove difficult to erase, particularly in the eyes of his family, close associates and, ultimately, the voters who placed their trust in him. Of course, it is common knowledge that politics can be a dirty game and that, as Lord Acton famously observed, “power tends to corrupt, and absolute power corrupts absolutely.”
Yet, nothing could be more devastating than a person losing his own soul in the process. On the one hand, stepping down could be construed as an admission of responsibility for the allegations levelled against him. On the other, allowing the No-Confidence Motion (NCM) to proceed could expose him to further public scrutiny and potentially inflict lasting damage on his character, dignity and reputation. Thus, he finds himself caught between two unenviable choices, each carrying consequences that may extend far beyond the immediate political fallout.
The Speaker is therefore confronted with a classic Hobson’s choice, with neither option likely to be without consequences. After all, in politics, there are no permanent friends or enemies—only permanent interests.
WILLIAM
Opinion
How long can Sri Lanka remain silent on its demographic crisis?
I write this with a sense of profound disappointment, rather than as a critic of the government or any individual public official. For several months, I have been drawing public attention to what I consider one of the most serious long-term challenges facing Sri Lanka—the country’s rapidly changing demographic structure, declining fertility, population ageing and the consequent contraction of the working-age population.
I have written several articles on this subject, believing that informed public discussion could encourage policymakers, academics and relevant institutions to examine the issue before its consequences become irreversible. I went a further step by addressing a detailed letter to the President on 28 August 2026, seeking consideration of a National Demographic Action Plan.
That letter was not merely an expression of concern. It contained practical proposals: long-term demographic projections, assessment of the consequences for labour supply and productivity, examination of declining fertility and delayed family formation, reassessment of education and employment policies, consideration of migration, and the establishment of continuous demographic monitoring.
I deliberately addressed the matter to the highest level because demographic change is not the responsibility of one ministry. It cuts across Finance and Planning, Education, Labour, Health, Higher Education, migration, social protection and national human-resource planning.
Yet, after sending that registered letter, I have not even received an acknowledgement.
This is what troubles me most. I fully appreciate that government has numerous urgent problems to address. Economic recovery, disaster management, employment, education and many other immediate concerns understandably demand attention. But demographic change is different. It operates slowly, almost silently, while steadily narrowing the choices available to future governments.
By the time the shortage of workers, accelerated ageing, increased dependency and the economic consequences of very low fertility become impossible to ignore, remedial action may be enormously more difficult and expensive. What is equally disappointing is the apparent silence of the institutions that should be at the centre of this discussion.
The latest Census has provided the country with an invaluable body of demographic evidence. My own published work has attempted to connect those findings with national development, productivity, education, employment and human-resource planning. On the top of these endeavours, I have seen voluminous articles written by Professor Manori Weerathunga, of the Population Department of the Colombo University, President Population Association of Sri Lanka, and Director Centre for Ageing Studies of University of Colombo. Yet I have seen little evidence of a visible national policy response from the relevant planning and statistical authorities.
Given the multiplicity of the roles and the credentials she possesses, I would strongly urge her to take the bull by the horns and formulate a draft national demographic policy with the expertise of the demographic scientists. This task cannot be delegated to the SLAS or Planning panjandrums. The government should seriously think why the thinktanks are abdicating their mandatory responsibilities and playing a passive role when the country is confronted with burning issues. Are there any sinister plans by disgruntled senior officers to derail the development plans is the question that begs an answer? Alternatively, the government should seriously enlist the support of the IMF or the World Bank, before the demographic bomb explodes!
Are we treating the Census merely as a statistical exercise, rather than as an early-warning the system for national planning? This question deserves a public answer.
I went even further by writing on “Educational Delays, Biological Clock and Sri Lanka’s Fertility Crisis.” My purpose was not to blame the education authorities. I sought to draw attention to the possibility that prolonged delays in university education, examinations, admissions and graduation may interact with delayed family formation and the biological realities of childbearing. I had hoped that this would stimulate examination by the Education sector and other relevant stakeholders.
Unfortunately, I have yet to see any meaningful response. My concern is therefore not whether my own articles have been acknowledged. That is completely irrelevant. The issue is whether the substantive national questions raised in those articles are being examined by anyone in authority.
A citizen who spends considerable time studying a national problem, writing about it publicly and then submitting a constructive proposal to Government should not necessarily expect agreement. But surely an acknowledgement—or better still, a response indicating that the matter is being examined—is not too much to expect.
There is also another dimension which I recently highlighted in discussing Sri Lanka’s transition from an “Age of Longevity” towards an “Age of Experience”. Sri Lanka is simultaneously facing a shrinking younger workforce and an expanding reservoir of older citizens possessing decades of professional and institutional experience.
The demographic challenge, therefore, should not be viewed only through the lenses of pensions, healthcare and elderly care. The country must also ask how the accumulated knowledge, expertise and institutional memory of its experienced citizens can be mobilised for national development.
This is precisely why I find the present silence so difficult to understand. I have no personal or political agenda. I have spent decades working in human resources, productivity and management specialist, and I have chosen in the later stage of my professional life to devote my writing to contemporary national issues which I believe deserve national attention.
Perhaps my concerns are misplaced. Perhaps the government already has a comprehensive demographic strategy under preparation. The relevant institutions have already initiated studies that are not yet public.
If that is the case, I would be delighted to be proved wrong. But if no such comprehensive process exists, then I respectfully ask: how much longer can Sri Lanka afford to remain silent?
The demographic clock does not stop while governments deliberate.
My appeal is therefore not for recognition of my efforts. It is for recognition of the problem. I hope the relevant authorities will prove that the silence I have encountered is not indifference, but merely the silence before meaningful action.
Sri Lanka cannot afford to discover, ten or twenty years from now, that the warnings were visible, the evidence was available, the proposals were made—and nobody acted.
The time to respond to the demographic crisis is now, while choices still remain.
Over to you, the President, the Prime Minister, the Minister of Finance and National Planning, Vice Chancellor of Colombo, Director General of Census and Statistics.
Athula Ranasinghe
Productivity Specialist and Management Consultant
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