by Dr. Harold Gunatillake, Cosmetic Surgeon, Oasis Private Hospital
Long time ago we used fat in our cooking because it made our cooking tastier. Lard (pork fat), tallow (beef or mutton fat), butter, margarine, shortenings, were freely used. We spread butter on our boiled hot potatoes, ghee in our boiled white rice, and enjoyed that mouth feel, and the unique pleasurable tastes. During festivities, we ate sweat meat, Bombay sweats, Dodhols, musket, and all that stuff, and then we washed our hands repeatedly with soap and water, to remove all that oil.

Men, women and children started putting on weight, incidence of obesity, heart disease, cancer doubled, and the word got round that diets high in fat were related.

Then a ‘Fat Phobia’ developed among people and avoided eating fats. We then realized that all fats were not bad for us. We also then realized that there were many varieties of fat, some of them worse than others. In addition to saturated, monounsaturated and polyunsaturated fats, there were trigycerides, trans-fatty acids, and omega 3 and omega 6 fatty acids.

We were told to avoid saturated fats, so our kitchen staff shaved off the surface fat under the skin off meat, steamed and boiled, to drip off the fat within, removed the skin from the chicken, substituted margarine for butter, and there was a complete change in our cooking process, by selecting cooking oils extracted from nuts, seeds and fruits. Coconut being a vegetable saturated fat also got labeled as a bad fat. This label was so stuck, even today, our housewives are reluctant to use coconut oil for cooking.

Fats are a group of chemical compounds formed of fatty acids. Nature has created this compound to store as food in the body, needed at times when it is scarce. Fats are needed in the diet to supply essential fatty acids that are not produced in the body. They are needed to absorb the fat soluble vitamins like A, E and D from the gut. They are needed for hormone production, for the immune system, and so many other functions to maintain normal health.

Dietary guidelines endorsed by the U.S. Department of Agriculture and the U.S Department of Health and Human Services advise consumers to: reduce total dietary fat intake to 30 percent or less of total calories. Reduce saturated fat intake to less than 10 percent of calories, and reduce cholesterol intake to less than 300 milligrams daily.

Recently a new term has been added to the fat lexicon; trand fatty acids. These fatty acids are beneficial to increase the shelf life of processed foods, including margarine. These are extracts from seeds and nuts, such as corn, sunflower, safflower, containing poly-unsaturated fatty acids. Some of the missing hydrogen atoms in these polyunsaturated fats are put back in a chemical process called ‘hydrogenation’, resulting in "straighter" fatty acids that solidify at room temperatures.

These man made fats are treated in the body as saturated fats, causing the same health problems as natural saturated fats.

Cholesterol is sort of a "cousin" of fat, and belongs to a larger family of fats called lipids. The daily body requirement is manufactured by the liver. Some researchers say that less is manufactured in the liver and the rest have to come from food we eat. This theory may be true because the bile salts produced in the liver excretes cholesterol, and the same bile salts facilitates further absorption of cholesterol from the digested fatty foods in the gut.

Cholesterol is used to build the cell membranes, brain and nerve tissues. Cholesterol helps the body produce steroid hormones needed for body regulation.

The cholesterol is transported in the bloodstream in large molecules of fat and protein called lipoproteins. Cholesterol carried in low-density lipoproteins is called LDL- cholesterol, the ‘bad fellow’. This bad fellow is not that bad as we label it. It is very inert, waxy and yellowish in colour. LDL-cholesterol do settle down in minute arteries, and cause no problems. They are kept inert by anti-oxidants like vitamin E. Free Radicals in the blood stream attack these inert settlers, and make them active. The immune cells in the locality engulfs these free radical attacked, active LDL-cholesterol, and are named ‘foam cells’. It is the foam cells that cause the blockage, leading to heart attacks and strokes. Some authorities do not believe this theory.

Cholesterol carried in high density lipoproteins is called HDL-cholesterol, referred to as the ‘good fellow’. When you check your total blood cholesterol level, it is most vital that you check your HDL-cholesterol level. Elevated HDL cholesterol destroys the bad fellow, keeping your minute blood vessels un-obliterated, and protected against heart disease.

Cholesterol is measured in milligrams per deciliter (mg/dl) of blood. A deciliter is a tenth of a liter. It is recommended that the total blood cholesterol be kept below 200mg/dl. The average in Sri Lanka is above this level. This was attributed to the high consumption of coconut meat, and oil used in cooking. This fallacy is been disproved today. In the United States the food industry has reverted back to the use of coconut oil, and in fact there are ‘coconut diets’ for weight reduction.

According to the National Heart, Lungs, and Blood Institute in the States (NHLBI), a component of (NIH), a healthy person who is not at high risk for heart disease and whose total cholesterol level is in the normal range ( around 200mg/dl) should have an HDL-cholesterol level of more than 35 mg/dl. An LDL-cholesterol level of less than 130mg/dl is desirable to minimize the risk of heart disease. (In Australia, and some other countries the cholersterol in the blood is measured in millimols/litre, and the normal range is between 3.5 to 5.5mmols/L)

As mentioned before the dietary cholesterol has no influence on blood cholesterol level. Nevertheless, some studies have shown that eating cholesterol increases the risk of heart disease even if it doesn’t increase blood cholesterol levels.

In addition to the total cholesterol and HDL-cholesterol levels, the triglycerides levels should also be checked, on a regular basis.

Triglycerides is another form in which fat is transported through the blood to the body tissues. The excess fat in the blood is stored as triglycerides in the body. Another lipo-protein -very low density lipoprotein or VLDL — has the job of carrying triglycerides in the blood. The level of triglycerides should be below 200mg/dl as recommended by NHLBI. It is not clear whether high levels of triglycerides alone increase an individual’s risk of heart disease. Triglycerides also prevent HDL-cholesterol attacking the LDL-cholesterol. For some reason the triglycerides level are high among diabetics, those suffering from kydney disease, and among those who indulge in excessive alcohol. Many people who have high triglycerides also have high LDL-cholesterol or low HDL-cholesterol

Public Health advocates have long recommended that individuals limit their cholesterol consumption to 300 milligrams per day. Those who eat eggs daily should know that each egg contains as much as 213 milligrams of cholesterol. This restricts the egg consumption to about 3-4 per week.

Over the years there has been considerable debate whether eggs in the diet contribute to elevated plasma cholesterol level, leading to heart disease risk. Thirty years of accumulated research in America showed that dietary cholesterol has only a small effect on plasma cholesterol levels, and that dietary cholesterol has little relationship to heart disease incidence.

The April 21st issue of the Journal of the American Medical Association (JAMA1999,281;1387- 1394) reported a study by Hu and colleagues from the Harvard School of Public Health, found no relationship between egg consumption and heart disease, in a population of over 117,000 nurses and health professionals followed for eight to fourteen years. They also found that there was no difference in heart disease relative risk between those who consumed less than one egg a week and those who ate more than one egg a day. The Harvard investigators have also reported that dietary cholesterol was not a significant factor in coronary heart disease risk in either the Nurse’s Health Study or the Health Professionals Follow-up Study. Similar findings of a non-significant relationship between dietary cholesterol and coronary heart disease risk have been reported from the Lipid Research Clinics Follow-Up Study, (Framingham Heart Study). Data from the Multiple Risk Factor Intervention Trial (MRFIT) actually reported an inverse relationship between dietary cholesterol intake and plasma cholesterol levels, .and also an inverse relationship between egg consumption and plasma cholesterol levels.

Further evidence from the National Institute of Health, in America, has noted eating one egg per day does not increase a healthy person’s risk of heart disease or stroke. However, the study of over 100,000 people did suggest a link between egg consumption and heart risk in diabetics, a finding that "warrants further research," write Dr. Frank Hu and colleagues at Harvard University in Boston.

The study also showed that consumption of up to 1 egg per day is unlikely to have substantial overall impact on the cardiovascular disease among healthy men and women.

In spite of high cholesterol content, eggs contain substantial amounts of healthy nutrients, antioxidants, folate, other B vitamins, unsaturated fats and amino acids, that are beneficial to our health.

Hippocrates, the father of medicine, on his philosophy about dieting said, "...Those desiring lose weight should perform hard work before food, They should take their meals after exertion and while still panting from fatigue.... They should, moreover, eat only once a day and take no baths and sleep on a hard bed and walk naked as long as possible."

Though walking naked is not acceptable today, Hippocrates did realise and recognise even 2,400 years ago, the relationship between food intake and energy expenditure.

Today the relationship between eating and daily exercise is well recognised. A brisk walk daily for twenty minutes, is recommended for the average people. Walking an hour per day is recommended to those who have had open heart surgery for coronary artery blockage.

The new U. S. guidelines place more emphasis than in previous editions on being physically active and maintaining a healthy weight.

As in America, the greater majority of children and adults in the metropolitan affluent society in Sri Lanka are over-weight. You only have to visit any beach resort, mid-day on weekends to notice the number of whole families treking in to enjoy the buffet lunch. These attractively table spread lay outs are full of tasty oily unhealthy foods, and it is shocking to observe their over-filled plates by these weekenders. Another observable feature is that the children are so over weight that there knees knock each other, and the parents are not aware of this deformity which further prevents them participating in school sports, adding more onto their weight problem.

The simplest natural remedy to correct this deformity is to make them wear well protected shoes with inside elevation of the soles and heels of the shoes. Also putting them on weight reduction diets will benefit in their motivation for healthy living.

Another factor to add to this food culture, is to watch the incidence of school children eating pastry foods, after school. Mushroom Pastry shops are prevalent in the neighbourhood of schools, in the cities and suburbs. These foods use polyunsaturated vegetable oils in baking at very high temperatures in the commercial ovens. Prolonged baked foods under very high temperatures, increases the production of ‘Acrylamide’ a recent finding. This chemical is carcinogenic when consumed in large quantities.

Children leave their homes in the early hours of the morning, rush into there school transport vehicles and travel long distances to school. For instance, children from Kegalle, Matale, and other far away places travel down to Kandy schools. Children from Negombo, Kalutara and other suburbs travel all the way to Colombo schools for their education. These children are fatigued by the time they reach school. You only have to see them in their vans going home after school, most of them fast asleep. No wonder they have to depend on fast foods, until they reach home for their mothers’ home cooked foods.

These children do not participate in sports activities after school. No wonder they are overweight. Being overweight increases the risk of chronic disease, including heart disease, strokes, diabetes, arthritis, breathing problems, high blood pressure, and certain types of cancer, in their later life. Malnutrition among school children is another subject.

The current American guidelines contain a Body Mass Index (BMI) chart, which replaces the weight-for-height chart found in previous editions. A calculation based on weight and height, BMI is used by health professionals to help determine if a patient is overweight, obese, or at a healthy weight.

You can determine your BMI by using the following formula:

1. Divide your weight (in pounds) by your height (in inches) squared.

2. Multiply the results of step 1 by 705.

For example, if you are 5’3"(63 inches) and weigh 138 pounds, the equation looks like this: BMI= 138/(63x63) x 705= 24.5

Your BMI should be somewhere in the 19 to 25 range. A BMI of 25 to 29.9 is considered overweight and a BMI over 30 is considered obese.

For the first time ever, these guidelines address food safety, particularly the need to store and prepare foods safely in the home. FDA works with other agencies to combat food-borne illness, an important public health concern.

(Does it worry you much seeing the ‘chappy ‘ cooking those hoppers, kotta roties with a big bang, and godhas, in the hotels, and on the way side, bare bodied, sarong tucked up, sweating, and picking the ingredients from unclean vessels with bare hands, cooking those oily unhealthy tasty hot ‘take a ways ‘ for you? Fortunately, these foods are cooked at high temperatures, and most germs perish).

These guidelines continue to emphasize balance, moderation, and variety in food choices. Whole grains, fruits and vegetables, and choosing a diet low in saturated fat, cholesterol, salt, and moderating sugar and total fat intake, are recommended.

To lose weight one should eat less calories than what one expends. One can do this by becoming more physically active, and making changes in your life style, including diet, so that the changes that you can maintain are for the rest of your life.

Do not indulge in ‘fad diets’. They are not practical, and you may not be able to continue for the rest of your life. All regimented diets have failed. You must first eat a healthy diet. Then, consider what you are eating. To lose weight while remaining healthy, you should try to lose only about 1/2 to 1 pound a week. One pound equals 3,500 calories. So if you cut out or exercise off 500 calories per day, you will lose about a pound a week. Isn’t it simple?

Cut down on fats, oils, and sweets. These groups add calories, and has little nutrient value. They include salad dressings, butter, margarine, sugar, sodas and candy. Eat sufficient from the grain group: breads, cereals, rices, pastas, and other foods made from grain. Eat sufficient fruits and vegetables. These foods are high in fibre can be an important aid in weight maintenance because eating enough of it can help make a person feel full and thus not eat as much.

Eat a third of your daily foods in the raw form. Whole cooked foods provide lesser amounts of the nutrients than comparable quantities of raw foods.

Eat moderately-cheese, poultry, fish and eggs, as well as nuts and beans. If you like alcohol, make it only a single daily drink. It adds calories.

Regular exercise is important for overall health, as well as for losing and maintaining weight. There is evidence to suggest that body fat distribution affects health risks. For example, excess fat in the abdominal area, as opposed to hips and thighs, is associated with greater risk for high blood pressure, diabetes, early heart disease, and certain types of cancer.

Brisk walking daily, calisthenics, gardening, sports exercises, and dancing, are excellent forms of exercises to sweat out those added fat round your tummy.

There are many diet pills available, some popular and others less popular. The earlier ones’ were Sanorex (mazindol), Adipex (phentermine), Tenuate Do span, Duramine (amphetamine), to mention a few. Xenical is the first in a new class of anti-obesity drugs known as lipase inhibitors. Lipase is the enzyme that breaks down fat in the gut. Xenical interferes with lipase function, decreasing the fat absorption by 30 per cent. This tablet needs to be taken only if you are indulging in a high fat diet. It does not mobilize fat stabilized within the body. It is expensive, and as well not mdulge in fatty meals.

Duramine is an appetite suppressant, taken one in the morning with breakfast. They come in 10mg, 20mg, 30mg. and 40mg tablets. Duramine makes you physically active, and may affect your sleep pattern.. Those people having high blood pressure should not take these tablets.

These diet pills must be taken with calorie restricted diets. They should be taken only for a short while, as they are addictive, except xenical. If you can motivate yourself for a calorie restricted diet, which itself will reduce weight, why spend money on these chemicals, which may have side effects? Do it the natural way for healthy results.