by Dr. Iain Corness
Hooray for Uncle Harry!
I can assure you that every practicing doctor in the world
has heard about your Uncle Harry who smoked three packs of cigarettes a day,
drank two bottles of whisky by lunchtime and lived to be 104 and was shot by a
jealous husband after being found ‘in flagrante delicto’. The story of Uncle
Harry is trotted out to stymie any thoughts of stopping smoking, or that too
much alcohol is really too much of a good thing.
Unfortunately, your unstoppable Uncle Harry means absolutely nothing when we
look at health risks from an overall point of view. Just as one swallow doesn’t
make a summer, one Uncle Harry does not prove that smoking isn’t dangerous, or
that too many bottles of whisky won’t cause cirrhosis. That kind of “proof” only
comes after looking at large numbers of Uncle Harry’s, and that is done by a
special group of people called epidemiologists.
Now the World Health Organization (WHO) has teams of epidemiologists and other
health watchers, looking at the spread of disease in the world. Not just Uncle
Harry. They have a good idea where we’re headed, but much of that depends upon
where we (you) are.
The WHO has data to show the major influences and risks to health, with the
number 1 global health risk appearing to be Underweight. Here is the influence
of the African continent, with malnutrition and outright starvation influencing
statistics. Again, it is the African continent that has dominated the second
major health risk - Unsafe sex. The HIV/AIDS epidemic in that region,
influencing the global statistics. After those two comes High Blood Pressure and
Tobacco and then Alcohol at number five, and so much for Uncle Harry.
However, if you split the statistics up and examine the situation in developing
countries, such as much of Asia, the picture is different. Number 1 health risk
is Alcohol, followed by High BP, Tobacco and being underweight.
A close look at the risks for the developed societies (that covers the
Europeans, Brits, Americans, Australians) gives yet another differing list with
top spot Tobacco, followed by High BP, Alcohol, Cholesterol and being
So, depending upon the society, the things that are waiting to get you are quite
different. A WHO report states, “As a country develops and more people buy
processed food rather than growing and buying raw ingredients, an increasing
proportion of calories tends to be drawn from sugars added to manufactured food
and from relatively cheap oils. Alongside the change in diet, changes in food
production and the technology of work and leisure lead to decreases in physical
The consequent epidemic of diet-related non-communicable diseases (obesity,
diabetes, hypertension and cardiovascular disease) is projected to increase
rapidly. For example, in India and China, a shift in diet towards higher fat and
lower carbohydrate is resulting in rapid increases in overweight - among all
adults in China and mainly among urban residents and high income rural residents
in India.” And have you noticed how many overweight Thais there are these days?
An interesting fact comes out of some developing nations, however, where
countries have taken it upon themselves to promote a healthier way of life,
despite the advent of the high living “western” style economy. Again, quoting
WHO, “The Republic of Korea is an example of a country that has experienced
rapid economic growth and the introduction of Western culture since the 1970s.
There were large increases in the consumption of animal food products, and a
fall in total cereal intake. Despite this, national efforts to retain elements
of the traditional diet - very high in carbohydrates and vegetables - seem to
have maintained low fat consumption and a low prevalence of obesity.
“The Republic of Korea has strong campaigns to promote local foods, emphasizing
their higher quality and the need to support local farmers. A unique training
program is offered by the Rural Development Administration. Since the 1980s, the
Rural Living Science Institute has trained thousands of extension workers to
provide monthly demonstrations of cooking methods for traditional Korean foods
such as rice, kimchi (pickled and fermented Chinese cabbage) and fermented
It’s not too late to look at your diet either! And put that cigarette out.
Poisoning your children
Did you know that the incidence of poisoning of children has
risen in the past few years? This is not deliberate poisoning by someone with
evil intent, but “accidental” poisoning where small children (toddlers
especially) are poisoned by taking something dangerous they have found in the
The concept of ‘child-proof tops’ has been about for many years, but I am sure
you have found that the majority of medications still have simple closures. And
where do the majority of these medications reside in your household? Probably in
the bathroom cabinet or in the fridge. Yes, your bathroom cabinet!
To show just how unfinished medicines can accumulate in your household (even
though you are supposed to take the complete course), one of the patients
brought me a present a couple of years ago. A very large package which weighed
1.44 kg. If this had been just before Xmas, it could have been all sorts of
goodies. (Miss Hillary in this section would have thought all her Xmases had
come at once! Chocolates at least!)
In fact it did contain all sorts of goodies. There were capsules, tablets and
lozenges and in all kinds of wonderful colors. These would have been a toddler’s
delight. And all potentially lethal.
The package was the result of the patient’s cleaning out of his bathroom
cupboard of outdated, or no longer needed, or even ‘unknown’ medicines. The man
was not a hoarder, but knew that medications should be kept out of the reach of
children, which he had been doing - for quite some time! However, when he
started running out of room, a problem presented itself. How was he going to get
rid of them?
He was savvy enough to know that if he just ditched them in the local rubbish
bin, the recyclers would definitely consider them treasure trove, and he could
foresee some untrained person attempting to differentiate the various pills and
tablets and sell them somewhere. Paracetamol tablets do generally look the same
after all, white round ones, but so also do many other medications, which are
not as relatively safe to be taken indiscriminately.
He then thought about flushing them all down the toilet, but decided that 1.44
kg of strange tablets might just block the precarious plumbing that pervades in
Thailand. When the locals are afraid of putting soluble toilet tissue down the
loo, what would strange foaming tablets do? Let alone capsules and lozenges.
The next resort was to borrow a mortar and pestle from the local ‘som tum’
roadside kitchen and having ground them all to a paste then spread the resulting
pulverized mass over the garden as a somewhat powerful weedicide. At least the
grass would be germ-free! However, this was not really practical either, as the
som tum lady couldn’t wait the several hours that was going to be necessary.
So I then became the last option, and with a smile he presented me with the
aforesaid 1.44 kg bag, with wishes for a very happy Khao Pansa.
Abandoning my initial thoughts of hurling them from the top of the 15 storey
hospital building and watching people scrabble for free tablets, I saw the
senior pharmacist in charge of the Pharmacy at the Bangkok Hospital Pattaya who
assured me that yes, they could dispose of the 1.44 kg bag and contents, as
there was a service to allow total destruction of medications such as these,
under very secure circumstances, run by the Thai government, and he would be
happy to forward the 1.44 kg bag of goodies.
So there you are. It is probably a good idea as part of your New Year’s
resolutions, to clean out your bathroom cabinet of old, half used, undated,
expired and unknown medications, tablets, lozenges and mixtures. If the quantity
is too great for flushing down the loo (and 1.44 kg is too great), then bring
them to the closest hospital and ask that they supervise the destruction.
Of course, as mentioned above, when you are prescribed a course of medication
(antibiotics in particular) you should keep taking them until the course is
finished. We don’t prescribe ‘extras’ just to fill up the bag!
Seven Deadly Sins!
Were you aware that heart disease is
still one of the greatest killers of mankind, ranking a strong second after
the Thailand motorcycle riders road toll - OK, I exaggerated that a little,
but the road toll in this country is a blight on the face of the community.
Interestingly, if you look at the major causes of death by development of
the countries, in the high income countries death toll comes from heart
disease, stroke and lung cancer, middle income countries have stroke, heart
disease and lung disease and for the low income countries it is heart
disease, respiratory infections and then HIV/AIDS.
There are many reasons for the differences, including dietary,
socio-economic, educational, development of health services and tobacco and
alcohol abuse. However, this week I am only going to address heart disease,
and the seven deadly ‘sins’ that can predict your likelihood of getting (and
suffering from) heart disease.
1. High Blood Pressure: 20 percent of elderly people suffer from this
condition. Imagine trying to blow through a long tube. If the tube becomes
constricted for any reason, you will have to blow harder, increasing the
pressure. Blood pressure is the same - if the arteries are constricted or
less pliable, it takes a greater pressure to force the blood around. The
heart has to work harder to produce the increased pressure, and eventually
the heart gets tired and fails.
2. High cholesterol: High cholesterol foods such as egg yolk, offal, animal
brain, animal fats, dairy products, seafood, oyster, squid, etc, leave
deposits in the blood vessel walls. As a result, the fat “plaque” on the
vessel walls obstructs the blood flow and this will eventually cause heart
disease, as per the first deadly sin above.
3. Smoking: Smoking is a primary factor in the causation of coronary artery
disease. Smokers are at a much higher risk, even two times more than
non-smokers. Smoking increases adrenaline, which causes an increased heart
rate, increased blood pressure and lowers the amount of oxygen carried by
4. Diabetes: Diabetic people have twice the risk of congestive heart failure
than people with normal blood sugar levels, due to their increased weight
(see number 5) and high cholesterol levels produced in the blood.
5. Obesity: People who are fatter than average have to face a 30-40 percent
increase in risk of heart disease compared to thin people. In just carting
around the extra weight, the heart has to work harder (and the knee and hip
joints wear out). Try walking around with 10 kg extra on your back and tell
me how you feel at the end of a week. Tired? Of course. And your heart is
6. Stress: Stress is not totally bad for us, as it keeps you going, and in
an appropriate level actually stimulates our curiosity and motivation;
however, by getting over-stressed, adrenaline levels are increased and this
may lead to abnormal heart function. Though stress is not the main cause of
heart disease, it can make the artery walls less flexible, which is the
beginning of heart disease.
7. Lack of exercise: Exercise is the best way to increase high density
lipoprotein (HDL) - “good” cholesterol that prevents the arteries becoming
abnormal. By exercising, blood pressure, body weight, and the possibility of
thrombosis will be reduced.
So you can see just how these seven risk factors all are inter-related. Keep
the arteries clean, watch the diet and ensure you have a reasonable level of
exercise. Check the Blood Pressure and stop smoking.
Remember too, that as you get older, the chances (and risks) of heart
disease are higher. (Young males are more likely to die from clumsy
motorcycle parking.) Statistically, men aged over 40 years as well as the
postmenopausal women have a higher risk than adolescents.
Despite our knowledge, we still cannot predict exactly when the demise will
come, but looking at the big picture, we do know that smoking, overweight,
unfit diabetics with high blood pressure and high cholesterol do not live as
long as non-smoking, fit, lean people with normal blood pressure, and normal
blood sugar and cholesterol levels.
Do you know your levels? A brief medical check-up will tell you.