8th June 1997

The heart of the matter

Traditional lifestyle reduces the risks of Coronary diseases

Your Health

by Dr. Sanjiva Wijesinha

"Rural Sri Lankan adults" says Professor Shanthi Mendis of the department of medicine at Peradeniya University, "have a low risk of coronary heart disease."

"It is the life style changes brought about by urbanisation that are probably the most important factors responsible for the current epidemic of heart disease in our country."

South Asians - and it matters not whether you are Sinhalese, Tamil or even Malayali - are genetically prone to the risk of heart attacks. This risk is kept under control by our traditional life style - where our typical villager is slim, has low cholesterol and rarely suffers from diabetes. Transfer such folk into an urban setting - whether in Colombo, Coventry or California - and soon the increased consumption of calories and fat, the increased level of stress and the low level of physical exercise all contribute to a huge prevalence of coronary heart disease (CHD).

"It is imperative" says Professor Mendis "that we take steps to control obesity and increase physical activity in our population."

One of the most important measures to prevent CHD is the promotion of healthy eating habits. Unfortunately we are often subject to a confusing and contradictory array of information about foods such as sugar, coconut oil, salt, coffee etc. Part of the problem is caused by the food industry itself; when scientifically proven advice threatens profits, manufacturers of unhealthy foods lobby fiercely, encouraging misinformation campaigns, attempting to discredit the evidence and keep controversy alive.

Our traditional Sri Lankan diet, rich in fruits and vegetables, contains plenty of antioxidants such as flavinoids and plant sterols which help prevent atherosclerotic clogging of the blood vessels. The fast food restaurants that have sprouted up all over our cities spell disaster for our younger generation - because the foods they sell are heavy with fat and salt.

Says Finnish dietician Kaija Savihlati "A man burns up 15 kilocalories per minute by jogging. Eating 100 grams of chips takes in 600 kilocalories - so if you think that you can get rid of this excess energy by exercising, you will have to jog for 40 minutes just to burn up this snack!"

How much exercise is necessary to prevent CHD? 30 minutes of moderate activity (brisk walking, gardening, cycling, swimming etc.) on 3 to 4 days of the week is the current recommendation. Even if you cannot achieve this much, you will reduce your risk of CHD by increasing your physical activity.

Unfortunately, for a nation to develop into an active society is not easy - as most folk find that lazing at home and travelling by car is far more attractive than walking!

Consuming excess salt is known to increase blood pressure, which is a potent cause of CHD. Most of us eat far more salt than we require - so cutting down extra salt is important.

Alcohol too is a potent killer. While one drink per day (a glass of wine, half a pint of beer or a single shot of spirits) provides a moderate protective effect, advice from one’s doctor to "take an occasional drink" can easily be misinterpreted. Such advice, capitalised on by the liquor industry, can encourage excessive intake - which tilts the balance in the wrong direction by increasing blood pressure and causing flabbiness of the heart - a condition termed cardiomyopathy.

Cigarette companies, while they do a tiny bit of good by sponsoring sports activity, continue to do an incredible amount of harm. "Nowadays" says American Conly Bost, an active anti-smoking campaigner in North Carolina, "they are not only directing their activities towards poor countries with a vengeance - they are also dumping cigarettes with a very high nicotine and tar content in Asia and Africa."

Since victims of cigarette-induced diseases in places like the USA have successfully sued tobacco companies there for millions of dollars, and since government controls in poor countries are far less stringent, these tobacco companies have now turned to the gigantic potential markets of the highly populated Third World.

As for reducing cholesterol levels in our population, it is still too early to know if lowering cholesterol too much is dangerous - so the widespread use of expensive lipid lowering drugs cannot be recommended. For people with an unacceptably high cholesterol and triglyceride level, such drugs (taken when recommended by a competent doctor) are certainly useful. Says Colombo cardiologist Dr. Rohantha de Silva, "It is important that people understand that these are not drugs to be taken for one or two months and then stopped - they have to be taken for a long period of time, possibly permanently, to exert their beneficial effect."

Perhaps the most important factor in preventing CHD is for people, especially young people, to be aware of the problem - and to become motivated enough to want a healthy life style.

Otherwise what will happen is that the current epidemic will see more and more Sri Lankans dying in their forties and fifties - of preventable heart disease.

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