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Non-alcoholic fatty liver: the twin of diabetes

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In an interview with Sunday Island, Prof. Anuradha Dassanayake, Consultant Physician and Professor in Pharmacology with special interest in liver disease from the Faculty of Medicine, University of Kelaniya throws light on non-alcoholic fatty liver disease (NAFLD) which is affecting almost 60% of middle aged and the elderly population and around 10% of adolescents in Sri Lanka. It is also known to be the ‘twin of diabetes’. The ‘grim and grave’ situation of NAFLD calls for recognition of it as a ‘health emergency’ today says Prof. Dassanayake

by Randima Attygalle

A precursor to cirrhosis and liver cancer, NAFLD is caused by accumulation of extra fat in liver cells that is NOT caused by alcohol. Largely triggered by fast food and lack of exercise, NAFLD is more prevalent among South Asians.

“The research confirms that even in countries such as the UK, NAFLD and cirrhosis are more common in those of South Asian origin,” explains Prof. Anuradha Dassanayake. He also says that genetic involvement of NAFLD is also notable. “Those with a family history of liver disease or liver cancer are more susceptible to develop NAFLD at a young age and they have a higher risk of developing cirrhosis by the age of 50 to 60.” Metabolic risk factors for NAFLD include cholesterol, heart disease and diabetes. Smoking and alcohol progress liver disease very rapidly.

Excess calorie intake which is accumulated as fat all over the body, leads to obesity which is a risk factor for NAFLD. This excess fat is harmful to multiple organs in the body including the brain, liver, kidney and the heart. The excessive fat however is not derived only by eating ‘fatty meals’ such as processed meat and fried food but also by excessive carbohydrates and sugar, all of which is converted to fat in the end, points out Prof. Dassanayake.

“Wherever there is fast food, NAFLD is inevitable along with diabetes and heart disease,” says the senior consultant. “While it takes about two hours for a square meal to be prepared at home, it takes just two minutes to get a fast food meal which has no fibres but fortified in calories and carbs which is a very dangerous combination.” Saturated fats and calories of fast food make permanent changes in gut microbiota by altering the ‘friendly microorganism’ (which is required for gut health) into dangerous organism. “Once such permanent change is made, it is hard to shed body fat, even if you eat very little,” Prof. Dassanayake explains. Fructose syrup which is made out of corn is also ‘deadly for the liver’ he says. “Fructose is sweeter and cheaper compared to table sugar and is often found in commercially prepared sweets and beverages.”

The sedentary lifestyle which compounded by the COVID-pandemic is likely to see a rise of increased number of NAFLD cases including children, observes the Consultant. “Lack of physical exercise, increased screen-time before computers, phones and TVs are making most children overweight or obese which is a precursor to NAFLD.” A recent study from the Central Province reveals that about 20% of the estate workers have NAFLD. This is largely attributed to their diet of all-carbs with no fibre, points out Prof. Dassanayake.

The condition which is also considered the ‘twin’ of diabetes, will lead to an epidemic of cirrhosis (the progressive phase of NAFLD where the liver is hardened) in the next 20 years, unless a global campaign declaring it a ‘healthy emergency’ is realized, warns the physician. “NAFLD is not yet found in any of the world’s non-communicable disease (NCDs) control programmes. The epidemic of cirrhosis which is predicted in the next 15 to 20 years is going to be an absolute tsunami-like disaster and worst of it is that the world is still not prepared for it.”

 

The strong link between diabetes and NAFLD is now established, points out Prof. Dassanayake. “Today Diabetes organizations world over, recommend the screening of all diabetics for NAFDL.” The physician also explains that almost all people who develop NAFDL will end up with diabetes and if it’s diagnosed early, lifestyle modifications such as healthy eating and reducing weight can reverse the condition. “Coffee is often encouraged among those with NAFDL,” he says.

A silent killer, NAFLD is mostly asymptomatic (showing no symptoms. “While a few may experience a dull pain on the right side of the stomach below the rib cage, most will not be aware until it has progressed to cirrhosis or worse, liver failure marked by swelling of legs and stomach and vomiting of blood, hence it is very sinister,” the physician warns.

Several blood tests and new tools such as the Fibro Scan can diagnose NAFLD. “If you catch it early of its onset, it can be reversed by losing 10% of the body weight. While management of NAFLD with drugs is minimal, lifestyle modification is what physicians encourage. However, if it has progressed to cirrhosis, as it happens in 10% of all people with NAFLD, there is no alternative other than a liver transplant which is a costly affair,” says Prof. Dassanayake.

Annually around 3,000 patients die of cirrhosis here at home and only about 10 transplants can be performed locally, says the physician. “This is due to lack of resources and the difficulty in finding suitable non-fatty liver donors. Only a few can afford to get a transplant overseas and the situation of a large majority is very grim. Sadly without a transplant, there is absolutely no hope for these patients.”

Debunking myths such as ‘long term diabetes drugs could cause fatty liver’ and that ‘fatty liver is harmless’ , Prof. Dassanayake reiterates that the condition is a red flag and urges people to eat healthy and watch their weight. “If you have a fatty liver at 25, you are likely to develop diabetes by 35 and suffer a heart attack by 45, such is the gravity of the condition. The good news is that unless you have a very nasty gene which triggers it, NAFLD is a preventable condition.”

Encouraging people to revert to the traditional Sri Lankan diet with moderate rice consumption, Prof. Dassanayake also calls for enhanced health literacy. “Unlike the good old days, where Sri Lankans were physically active, today many spend sedentary lives, hence they need to be conscious of their daily rice intake and also be conscious of the BMI value (Body Mass Index which articulates the ideal weight against height).



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The poem Neruda never wrote

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In an exclusive interview with the Sunday Island, film maker Asoka Handagama shares the story behind his latest film- Alborada (The Dawning of the Day) inspired by the celebrated poet Pablo Neruda’s stay here as the Chilean Consul. The film is to be internationally premiered at the 34th edition of the Tokyo International Film Festival opening on October 30.

by Randima Attygalle

It is the year 1929. Young Chilean poet and diplomat Pablo Neruda whose fame preceded him arrives in the British-occupied Ceylon as the Chilean Consul. By then Neruda, had already become an international literary celebrity. His work, Twenty Love Poems and Song of Despair was among the bestselling books of poetry in the 20th century. He was called ‘the poet of the people, the oppressed and the forgotten.’

The activist-Consul arrives in Ceylon, barely 25 and empty-handed except for his memory of the disengaged relationship with his former Burmese lover, Josie Bliss. She was obsessively devoted to Neruda and possessed by an overwhelming jealousy. Neruda who called Josie ‘a love terrorist’ and ‘a species of Burmese Panther’ would document in his memoir: (completed shortly before his death in 1973) ‘Sometimes a light would wake me, a ghost moving on the other side of the mosquito net. It was Josie, flimsily dressed in white, brandishing her long, sharp knife. It was she, walking round and round my bed, for hours at a time, without quite making up her mind to kill me. When you die, she used to say to me, my fears will end.’

While his ‘Bliss’ was turning into a taunting jealousy, Neruda receives a cable from Santiago informing him of his immediate transfer to Ceylon. Welcoming his emancipation from his lover, Neruda settles in a beach-front cottage in Wellawatte and is taken care of by a man servant.

He attempts to bury his memories in the vast tropical shores and takes refuge in an atmosphere of solitude he creates for himself. In his memoir is a chapter dedicated to his stay in Ceylon titled Luminous Solitude where he writes: ‘each morning I was overpowered by the miracle of newly cleansed nature.’

Neruda was soon found in the artistic inner circles of Colombo. He was acquainted with Lionel Wendt and George Keyt. The young Chilean poet had a bevy of female admirers whom he called ‘dusky and golden girls of Boer, English and Dravidian blood.’ They bedded him ‘sportingly, asking for nothing in return,’ as he documents.

The young diplomat was infatuated with a Tamil woman of a low caste who came every day at dawn to clean his outdoor latrine. He found her to be the most beautiful woman he had seen in Ceylon. To win her attention, Neruda left her gifts of fruit or silk on the path leading to the latrine, but she took no notice of them. One day he gripped her by the wrist and stared into her eyes. ‘Unsmiling, she let herself be led away and soon was naked in my bed. Her waist, so very slim, her full hips, the brimming cups of her breasts made her like one of the thousand-year-old sculptures from the south of India. … She kept her eyes wide open all the while, completely unresponsive. She was right to despise me. The experience was never repeated.’

The act became a subject of international scrutiny in later years, even prompting a reassessment of the Nobel Laureate’s merit. Neruda who was celebrated as ‘the greatest poet in the 20th century in any language’ by Gabriel Garcia Marquez was even labeled a ‘rapist’. Activists challenged his documentation of ‘she let herself be led away’ as a blatant lie. The decision to rename Chile’s busiest Santiago International Airport after Neruda was met with outrage from human rights activists who argued that the honour was inappropriate for a man who admitted to rape in his own memoirs.

“Although there are many accounts of Neruda’s life portrayed in fiction and film, this part of the story is often carefully left out. Though his poems about love outwardly sound romantic, they hide within them the eroticization and objectification of women and particularly, women of colour,” reflects the film-maker Asoka Handagama whose latest film Alborada (The Dawning of the Day) is an elaboration of Neruda’s controversial sexual assault.

The film which is to hold its world premiere in Tokyo (Oct. 30 – Nov. 8) is a fictionalized account of Neruda’s stay in Sri Lanka (then Ceylon) from 1929 to 1931 as the Chilean Consul. The film explores the psychological and the emotional factors behind Neruda’s attraction to a woman bound by her caste: a woman considered to be ‘untouchable’, unknown to her playing a part in a bizarre fantasy that ended in a sexual assault.

A fan of Neruda’s poetry, Handagama found the poet’s mixed element of art and controversy a tempting subject for a film script. The script which was inspired by Neruda’s Memoirs is a fruit of 10 years of research on the poet. Handagama left his position as a Deputy Governor of the Central Bank three years before his formal retirement age to complete what he calls his ‘dream film.’

A rebel himself with his cinematic expression, Handagama intrepidly unearths the famed poet’s often interred infamous chapter in what he calls an ‘ironic act.’ “It is ironic that an Asian film-maker, coming from a so called restrained cultural landscape is throwing light on Neruda’s sexual antics when all the while Western cinema makers and fiction writers chose to leave them out in the exposition of him,” smiles Handagama.

Reference to Neruda’s Burmese lover Josie Bliss in his poetry is plenty although she is widely regarded as a figment of the poet’s imagination, notes the film maker. “The depiction of her as a perceived threat, a desire and barbarity in his poem Widower’s Tango, combined with his confession show Neruda’s complicated relationship with women and race.” However, no poem of Neruda’s alludes to the ‘untouchable woman’ by whom he was smitten, despite being described as the ‘most beautiful Ceylonese woman’ or one resembling a ‘thousand-year-old sculpture’ from South India. Handagama’s tagline for his film, The poem Neruda never wrote validates this exclusion. It is also an allegorical reminder of the poet’s element which many tended to discount.

Alborada reinvents the rustic west coast of the island Neruda saw in the 1930s. This was no easy task says its creator. “We had to recreate Wellawatta of his time and this was not possible within Colombo due to the changing skyline. We set it up in Nonagama and in Ranminithenna Tele-Cinema Village.”

Lending a cinematic interpretation to an isolated incident at home which is unfamiliar to the authentic Sri Lankan film print, Alborada is to be a refreshing new experience for the local audience. The film also hopes to spur a public discourse, says its director. Starring Spanish actor Luis J Romero as Neruda and French actress Anne Solene Hatte as Josie, the dialogues are in English with Sinhala and Tamil subtitles. The film also debuts several artistes. The main cast comprises Rithika Kodithuwakku (Tamil woman), Malcolm Machado (Neruda’s man servant), Dominic Keller (Lionel Wendt), Nimaya Harris (Patsy), Thusitha Laknath, Kaushalya Mendis, Samantha Balasuriya, Kasun Perera and Kanchana Nandani. Edited by Ravindra Guruge, the film is produced by H.D. Premasiri.

The Tokyo International Film Festival (TokyoIFF) which will feature Alborada is among the invited films for its ‘international competition’ which is the highlight of the festival. Multi-award winning French screen and stage actress Isabelle Huppert will chair the competition jury. This year’s theme of TokyoIFF is ‘Crossing Borders’. “There are plenty of international film festivals today. But only 14 of them are regarded as ‘A-Grade film festivals. TokyoIFF is one of them and the only Asian festival to get this recognition so far,” remarks Handagama. This year’s festival will be opened with the world premiere of Clint Eastwood’s latest film Cry Macho.

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Fashion’s new order

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From fashion weeks without shows to brands abandoning the traditional schedules, Covid-19 has thrown the industry into a state of flux.

by Zanita Careem

As the pandemic spread and its impacts grew, business world-wide shifted their priorities. The virus has crept almost into every industry including the fashion industry.

It was a hard toll on the industry; fashion weeks got cancelled and major retail departmental stores closed for weeks and months.

The fashion industry is likely to see a shift from consumer spending in large department stores and choosing independent shops. The reason is because social distancing is a necessity. The pandemic slowdown affected the industry, the new normal made consumers to show down their purchases. The designers saw a huge shift in consumer behaviour, affecting the fashion designers and retailers alike.

To evaluate the impact of Covid-19 on the industry we caught up with some of the reputed designers whose names are synonymous with fashion. Senake de Silva said the future is bleak and until things go back to normal, (but how long) it will it take months or perhaps years. Even if we recover it will never be the same again. “We might get back to 70 per cent of what the industry was by next may be,” Senake said.

The Sri Lankan apparel industry was one of the most significant contributors to the country’s economy. “We even had the first ever Sri Lankan apparel fashion show at the then Hotel Oberoi. It was possibly the very first time that a top French Couturier was in Colombo,” recollected Senake.

Sri Lankan apparel categories include sportswear, lingerie bridal wear and swimwear. These were of high quality and were exported to many countries. Recently the industry was affected by regular disturbances of the Covid-19. Fashion shows were cancelled, designers had no work. Fashion industry is one of the primary employers too. With supply chain broken and sales down and unsold stock in retail outlets we had to face major crises. This was all against a backdrop of consumer habits changing and attitudes shifting to consumptions said Lou Ching Wong. We cant compare ourselves to the west said Lou Ching .

Despite the lock-down, major cities in Europe had their fashion shows. The luxury brands like Gucci, Prada, YSL, Armani and Chanel to name a few. But here at home with complete closure, there were no shows or glamour events.

Sri Lankans have now started to reassess and re-prioritize what they spend money on. This resulted in fashion trends slowing down with designers left with nothing. Major fashion brands and retailers have been cancelling orders, including products made and waiting to be sent to stores. The reality is that we are forced to stay at our homes and many of us are financially burdened by lay-offs and the desire to buy new clothes is a distant dream. How long can you think the domestic fashion industry can sustain without sales? “We work in a very high circle and the fact is there are no demands so, I am not sure this will be sustainable. And unfortunately we are not like a Western economy that can afford to payout salaries.”

The industry is going to take a long recovery time. The only positive, if at all is hopefully to be able to use it to recalibrate the lifestyles that suit our people said Lou Ching Wong.

“The virus has left me vulnerable confronting an obliteration of sales, wage loss and employee lay-offs,” Ramani Fernando, a fashion icon and beautician said. “However, we are slowly but steadily working towards providing services to our customers under strict health guidelines. Now things are changing and I find many brides advancing their dates and calendars are filling up. However, I feel this crisis could present an opportunity to rethink of the industry.”

For Dinesh Chandrasena, an internationally recognized designer and a leading creative educator, the future seems bright!

“The fashion design and apparel manufacturing industries like all other businesses have been continuously evolving despite the Covid-19 pandemic. We, like the other industries, have been finding methods and systems to not just survive but actually maintain a positive business movement. I have worked in the fashion industry in Los Angeles since the mid-1990s and I have many colleagues who speak about their plans and strategies. I notice that the long term systematic outcomes that they work towards, are based on utilizing these uncertain times to re-evaluate and re-structure their immediate sphere in order to maximize efficiency while still underlining creative excellence”.

“As a creative practitioner and educator, I look at everything with a ‘glass half full’ mentality and believe it is up to us to find, create, and enhance methodologies that would bring a successful turn to these times” Dinesh said.

The designers expect fashion to come back in a big way, after the pandemic. They believe that people will return to the world in glamorous, trendy outfits once more. ‘Fashion is a pendulum’ goes an adage. It goes from one extreme to another and that will happen again here too.

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Yohani has attracted many Bollywood singers

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Yohani de Silva popularly known as Yohani is as Sri Lankan singer, songwriter and rapper. Her song “Menike Mage Hithe” has completely exploded on the internet and had gone crazy visual. From social media to celebrities, everyone is obsessed with the peppy number. For the universal ‘Menike Mage Hithe’ is a 20-20 Sinhala by Satheeshan Ratnayake. The tract went viral after Sri Lankan singer’s version released in May. This song has created such a buzz, that it can be heard everywhere now.

Popularly known as Yohani,she was born on July 30, 1993 in Colombo.

She is extremely popular on Tick Tok and is also the first Sri Lankan female singer to have 2.46 million subscribers on You Tube Even celebs like Amitabh Bachchan, Salman Khan, Tiger Shroff and Maduri Dixit among others, couldn’t stop themselves from grooving to the addictive to the beat of the song. Many reels are also been made on this song of Yohani, and Amitabh Bachchan also shared one of his reels on his song on Instagram.

She did her schooling at Visakha Vidyalaya and graduated from Sir John Kotelawela Defence University. She holds a Bachelor of Science degree in Logistics Management.

Following the first Drive-in-Concert was produced by Show Town Entertainment and this concert created history as it was the first of its kind in Asia and the tenth worldwide. She shared the stage with great artists such as Bathiya and Santosh, Umariya and some others.

Yohani was now accepted as a Cultural Ambassador to India. Several TV channels in India interviewed her and said she is one of the latest Cultural Ambassador to appear in India’s National TV channel. Her song ‘Menike Mage Hithe” won the hearts of millions of people in India from celebrities to the public.

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