“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,
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)
Khan’s new war game
By Zahid Hussain
IMRAN Khan’s latest change of tack has caught his opponents by surprise. For months, the federal government had braced itself for a siege, and was reinforcing security around the capital. But the PTI’s decision to call off the march and dissolve the Punjab and Khyber Pakhtunkhwa assemblies has changed the entire scenario.It all happened on the eve of the change of guard in Pindi, lending a curious twist to the power game. The change of strategy came in the garrison city as the climax to the march that was aimed at forcing the government to agree to early elections.
It is apparent that the PTI’s months-long campaign could not achieve any of its objectives. But will Khan’s new move to checkmate the fledgling dispensation work? The dissolution of the assemblies in the two most powerful provinces and the possible pulling out of PTI members from the other provincial legislatures could certainly deepen the political crisis, making it harder for the fractious ruling coalition to survive.
However, it may not be the end of the game. While the PTI leadership has approved the decision, one is still waiting for its implementation. Apparently, there should not be any complication with the two chief ministers on board, but nothing can be taken for granted until it’s done. Notwithstanding its claims, the ruling coalition at the centre seems to have no power to block the dissolution. The option of governor’s rule may not be effective in this situation.
Indeed, the dissolution of the provincial assemblies will not constitutionally bind the federal government to dissolve the National Assembly and call for general elections. But elections in the two provinces within 90 days would change the entire political dynamics.Dissolution of the assemblies in Punjab and KP will deepen the political crisis.
Meanwhile, the PTI has also decided to approach the Speaker of the National Assembly to accept the resignations of its remaining lawmakers. With the PTI members absenting themselves from its proceedings, the National Assembly had already lost its effectiveness; the acceptance of the PTI resignations would only add to its dysfunctionality.The entire episode is set to completely destabilise the system. Can a weak coalition government withstand such mounting political pressure?
What is most alarming is the impending economic collapse and looming threat of sovereign default further complicating the situation. An inept government and its clueless finance minister do not seem to have any ability to deliver the country out of this mess. The rising current account deficit and runaway inflation have stifled economic growth.
Heightening political instability makes it much more difficult to stem the rot. The country is on a slippery slope with no hope of things getting better. We are witnessing what former finance minister Miftah Ismail describes as a “consistent downward slide”. But the dire warning about the sinking ship is drowned in the cacophony of a political blame game.
It’s not just a political or economic crisis; it’s a crisis of state in the midst of anarchy. With eroding state authority, the situation appears extremely grim. The worsening political instability has given space to non-state actors.There has been an alarming rise in militancy in the former tribal districts and other parts of KP. Banned militant outfits are back in action in some districts taking advantage of weakening state authority and political instability.
The return of militants to Swat valley more than a decade after they were driven out from the region by the Pakistan military indicates a failure of our national security policy. The reported presence of heavily armed men is reminiscent of the bad old days of Pakistani Taliban control in 2008. The resurgence of the militant network in Swat does not seem to be an isolated phenomenon. The TTP is now active in the former tribal areas too, particularly Waziristan.
Curiously, their activities seem to have increased after Pakistani security agencies entered into peace negotiations with the militant outfit operating from their sanctuaries across the border in Afghanistan earlier this year.
There is a strong suspicion that the militants returned to Swat as a result of a deal. Most of them had fled to Afghanistan after the military operation in 2009. They have reportedly been joined by local radical groups.In the midst of political chaos in the country, the TTP has called off a tenuous ceasefire and ordered the militants to launch attacks across the country. There is nothing surprising about the announcement; the ceasefire had never been implemented.
The so-called peace negotiations seem to have given space to the militants. According to media reports, the interior ministry has warned of some TTP factions joining the militant Islamic State group.Thousands of people have turned out in various parts of Khyber Pakhtunkhwa in recent weeks to protest against the resurgence of militancy and the inaction of the security agencies.
The residents have not forgotten the days when the rampaging Taliban had established a reign of terror in the area. The reassertion of militant groups could further destabilise the country.
Meanwhile, in the midst of chaos, the country has a new army command. The transition may have defused the controversy over the appointment but the challenges before the new chief are daunting. Although the security establishment has pledged to keep itself out of power politics, it may not be that easy, given how deeply the military is entrenched in the power structure.
There is always the danger of it getting sucked into the fray, with the political forces at war with each other.
Imran Khan’s latest move to dissolve the provincial assemblies may have pushed the ruling coalition into a corner but it has also intensified the political confrontation and deepened the chaos.The former prime minister can force the government to agree to an election date a few months earlier than the end of the National Assembly term. But it is doubtful that this would calm matters.
A major question is whether the warring sides can sit together to agree on a mechanism for free and fair elections. More important is how to deal with the worsening economic crisis and the resurgence of militancy that present a serious threat to national security.
The writer is an author and journalist.
Bali Declaration: Is it the clarion call to #endTobacco?
By SHOBHA SHUKLA, BOBBY RAMAKANT – CNS
Tobacco use is among the unhealthy behaviours that result in preventable burden of cancers, strokes, and heart diseases, said Budi Gunadi Sadikin, Indonesia’s health minister. In Indonesia tobacco use is the second largest risk factor for untimely deaths, he added. World Health Organization had earlier underlined that without clamping tobacco use, we cannot deliver on the promises enshrined in the Sustainable Development Goals.
Indonesia has walked the talk on building a grounds-up movement against tobacco. In 2011, twelve Mayors had come together to forge a Mayors’ Alliance to advance tobacco control in their respective cities. Today in 2022, there are over 150 Mayors of different Indonesian cities that are part of this Alliance, who are adapting as well as enforcing local laws to reduce tobacco use, said Dr Bima Arya Sugiarto, Co-Chair of Asia Pacific Cities Alliance for Health and Development (APCAT) and Mayor of Bogor City in Indonesia. “Mayors’ Alliance has been the main driver for banning tobacco advertising and promotion, as well as preventing tobacco industry interference in public policy” he said.
Both were speaking at the opening ceremony of 7th Asia Pacific Summit of Mayors (7th APCAT Summit or #APCAT2022) being held in Bali, Indonesia.Another sterling example of grounds-up tobacco control movement in Indonesia is the fact that “as of November 2022, over 300 cities have adopted the local smokefree laws,” said Dr Bima Arya.
That is why Indonesian health minister called for stronger partnerships “to reduce tobacco use” and “expand the on-the-ground effective programmes for tobacco control.”
“I would like to extend my gratitude to Mayors who have passed local smokefree laws. It is important for central government to collaborate with local governments to achieve tobacco control,” said the Indonesian health minister.
Despite alarming levels of tobacco industry interference, it is indeed commendable that Mayors and sub-national leaders of Indonesia have been able to advance tobacco control.
Agrees Kelly Larson of Bloomberg Philanthropies: “We acknowledge the role of sub-national leaders in Indonesia and commend the Mayors of over 300 cities who have passed local smokefree laws, that protect 75% of the country’s population from the hazards of tobacco smoke.” Kelly Larson shared that prioritising tobacco control and public health in New York resulted in increased life expectancy of 2 years for its citizens.
Not surprisingly, tobacco industry and its front groups are trying to create hurdles when local sub-national leaders try to advance tobacco control and health promotion. Effective enforcement of strong tobacco control laws hurt the industry profits. For instance, in 2017, Bogor City had become the first Indonesian city to implement a point-of-sale tobacco display ban as part of its smokefree law. But soon after a legal battle ensued. Finally, in February 2020, the city of Bogor won the court case when Supreme Court had upheld its ban on the display of tobacco products at point-of-sale.
While exposing how tobacco industry approaches election candidates to influence public policy, Mayor of Bogor City Dr Bima Arya said in 7th APCAT Summit opening session that “every candidate of local elections was approached by the tobacco industry…”
#APCAT2022 Declaration gives hope for a better tomorrow
“We, the delegates of the 7th Asia Pacific Summit of Mayors, recognize that APCAT is a vital platform to share experiences, shape local actions, and secure greater leadership as well as look for synergistic actions between specific health and development programmes.
We commit to accelerate progress towards eventually ending tobacco use, as well as preventing the avoidable burden of NCDs, eliminating Tuberculosis, and improving synergy between health and development programmes and promoting integrated responses where possible, thereby reducing disease burden and averting untimely deaths, by:
– Leading effective implementation of tobacco control programmes that include smokefree environments; a complete ban on tobacco advertising, promotion, and sponsorship; promotion of larger graphic health warnings with plain packaging on tobacco packs; smoking cessation programmes; and a ban on electronic cigarettes, heated tobacco products, shisha, and other similar products;
– Working with national government and policy makers to raise taxes and prices on unhealthy commodities (such as, but not limited to, tobacco products, alcohol, sugary and sweetened beverages);
– Ensuring accountability to prevent interferences and rejecting funding, logistics, donations, or grants from, and partnerships with, any entity related to any unhealthy commodity industries (such as, but not limited to, tobacco, alcohol, sugary and sweetened beverages);
– Investing in tobacco control for prevention of tuberculosis, non-communicable disease, and stunting. It includes smoking cessation in TB and NCD clinics, and family health programs; universal screening for TB and NCDs
– Adopting One Health approaches and processes to ensure that “a healthy city is a resilient city”.
Every tobacco-related death is preventable
The 7th Asia Pacific Summit of Mayors, which opened today in Bali, Indonesia, is jointly organised by the Asia Pacific Cities Alliance for Health and Development (APCAT), Ministry of Health, Republic of Indonesia; Ministry of Home Affairs, Republic of Indonesia; National Centre for Health Promotion, Ministry of Health, Cambodia; Bloomberg Philanthropies; Cities of Bogor, Denpasar and Klungkung of Indonesia; Balanga City, Philippines; Association of All Health Offices Indonesia (ADINKES), Indonesia Mayor and Regent Alliance, Indonesian Public Health Association; Udayana Central; Campaign for Tobacco Free Kids, Vital Strategies; Tobacco Free Generation International, The International Union Against Tuberculosis and Lung Disease (The Union); APCAT Parliamentarians and Asia Pacific Media Alliance for Health and Development (APCAT Media).
Over 1000 national and sub-national leaders, public health experts are attending the 7th APCAT Summit in Bali, Indonesia in person and virtually. Participants include mayors, governors, ministers, members of parliament, tobacco control advocates, and media from across the Asia Pacific region.
Over 8.67 million people die of tobacco use every year (out of which one million die due to second and third-hand tobacco smoke). Despite the crippling onslaught of COVID-19 public health emergency and humanitarian crises, tobacco industry has heightened its deceptive strategies to protect and expand its markets. In addition to the mountainous death toll and avoidable disease burden, tobacco use has also resulted in an annual economic loss of nearly USD 2 trillion to the global economy.
Achieving food security:Integrated plan necessary
BY Dr. C. S. Weeraratna
According to United Nations’ Committee on World Food Security, “Food security is achieved when all people, at all times, have physical and economic access to sufficient, safe and nutritious food to meet their dietary needs and food preferences for an active and healthy life. The Food and Agriculture Organization (FAO) and World Food Pogramme (WFP) estimate that 6.3 million Sri Lankans are facing moderate to severe acute food insecurity. This could be attributed mainly to shortage of food and high food prices. The latest WFP assessment reveals that 86 percent of families are buying cheaper, less nutritious food, eating less and in some cases skipping meals altogether. This unfortunate situation is the result of many factors among which are poverty, unemployment, decrease in land productivity, scarcity of foreign exchange reserves, depreciation of the local currency, etc. The report further states that the production of maize, mostly used as animal feed, is about 40 percent below the past five-year average, with negative effects on poultry and livestock production. Likewise, the production of vegetables, fruit, and export-oriented crops, such as tea, rubber, coconut, and spices, is well below average, causing a significant decline in households’ income and export revenues. The total cereal import requirement in 2022 is estimated at 2.2 million mt. In the first six months of 2022, more than 930,000 mt of cereals were imported, leaving an outstanding import requirement of 1.27 million mt. Given the persisting macroeconomic challenges, there is a high risk that the remaining import requirement will not be met.
In view of this situation, President of Sri Lanka has launched a programme to ensure food security in the country. The vision of this Food Security Programme is to ensure every citizen has access to enough food at a reasonable price to lead an active and healthy life and to ensure that no citizen of the country should starve due to lack of food and no child should be a victim of malnutrition.
Food Security was not an issue in the past. Even a few years ago we were almost self sufficient in rice. But, the foolish decision of the former President of Sri Lanka Mr. Gotabaya Rajapaksa banning imports of fertilizers such as urea and other agrochemicals affected local production of rice causing us to import rice which has resulted in lowering of food security level. Not only rice production, production of maize, mostly used as animal feed, vegetables, fruit, and export-oriented crops, such as tea, rubber, coconut, and spices, have been affected.
National food insecurity is due to many factors. Among these are wild elephants roaming in some of the dry zone villages causing death to many and destroying crops, Chronic Kidney Disease affecting thousands of farmers in the dry zone, inadequate water supply, lack of reasonable transport facilities, non availability of fertilizers such as urea, and other agrochemicals at correct times, inability to sell the produce at reasonable prices, land degradation etc. House-hold Food Security is closely related to the economy which has deteriorated during the last few years mainly due to drop-in crop production and several other factors. Prices of most food items have been on a steady rise since the last quarter of 2021 and reached a record high in August 2022, with the year-on-year food inflation rate at nearly 94 percent, further limiting the purchasing power of households.
According to Dept. of Census and Statistics around 14.3 % (nearly 3 million) are below poverty level. Unemployment, lack of resource production factors such as land and/or capital are the main factors causing poverty. Ill-health and sickness among family members, addiction to drugs and alcohol, frequently occurring natural disasters such as floods and droughts in some parts of the country, inborn defects such as deformities, blindness, inadequate knowledge on nutrition also tend to affect food security among households.
Land Degradation: One of the important contributory factors for the decline in the productivity of land is Land Degradation. Soil erosion, soil compaction, and nutrition depletion, cause productivity of land to decline, making crop production less profitable. In view of the importance of land degradation, the Ministry of Environment, in 2005, established an expert committee on Land Degradation and mitigating the effects of drought in SL. This committee comprised a number of experts in the field of land management and the main role of the committee was to advice the Ministry of Environment, on issues related to controlling land degradation. At the first national symposium on Land Degradation held in 2010, organized by the Ministry of Environment and the expert committee on Land Degradation, the participants, who were representing many land-related institutions in the country, revealed that a substantial amount of soil/ha/year is lost due to soil erosion. They were of the view that urgent action such as implementation of proper land use planning and the soil conservation and environment act etc. need to be taken by the relevant organizations to control land degradation.
Milk is an important food item for people, especially children. The total annual expenditure on importing milk and other dairy products is around Rs 40 billion. If we are to reduce our trade deficit which is around US. $ 10 billion annually and increase food security, increasing local milk production is important. To increase local milk production, a few years ago, the Government brought down 5000 heifers from New Zealand and Australia. The heifers imported were distributed among middle-scale entrepreneurs in Nuwara Eliya, Matale, Kandy, Kurunegala and Badulla districts. According to newspaper reports the Government had spent Rs. 520,000 per heifer and sold it to farmers at a lower rate of Rs. 200,000. It has been reported that some of the imported cows suffer from Bovine Viral Disease (BVD) and around 200 out of the 5,000 heifers imported to Sri Lanka have died without contributing to local milk production. Simply importing high yielding cattle will not increase milk production, unless they are properly fed and appropriate veterinary services are provided. Cattle imported from countries such as New Zealand and Australia are not acclimatized to local conditions and hence their productivity tends to decline. The farmers complain of insufficient pasturelands to feed the cattle. There is no appropriate programme to cultivate improved pastures such as Brachiaria sp. Napier and CO3. Pasture grasses can be grown under coconut but there was no effective programme to improve pasture production. It is foolish to import cattle to enhance milk production in the country without implementing an integrated programme to upgrade local cattle, making available cattle feed and improving veterinary practices in the country.
There are numerous organization in the country involved in various aspects of food security which is related to several Sustainable Development (SD) Goals. Authorities such as SDG council, Agric. Ministry, Paddy Marketing Board, Institute of Post Harvest Technology, Pulses and Grain Research and Production Authority, Research Institutes etc., need to take cognizance of all these issues and develop an integral plan and implement it if they are keen to achieve Food Security in the country.
Rs. 773 bn arrears: Go after massive tax dodgers before imposing new taxes – GMOA
Record number of students visited parliament on 01 Dec.
TNA MP vows to send China packing
‘Dates have the highest sugar content to fight Coronavirus’
Sunday Island 27 December – Headlines
U.S. Congress to probe assets fleecing by US citizens of Sri Lankan origin
Sports6 days ago
Cricket needs to address discipline issues
News5 days ago
SLPP dissidents ask govt. to bring back USD 35 bn ‘parked’ overseas
Sports2 days ago
Chamika under fire after chief selector opens can of worms
Features6 days ago
From Jungle To International Five-Star
Features4 days ago
Credibility in governance through elections and not security forces
Business4 days ago
‘JAT posts stellar Q2 – doubles PBT and commences manufacturing in Bangladesh’
News4 days ago
Easter Sunday terror attack suspect hacked to death
News3 days ago
New species of Nelu discovered from Knuckles