Beware the Tsunami of Non-communicable Chronic Diseases

Tue, Feb 26th 2013, 11:23 AM

Bahamians are watching a tsunami of chronic non-communicable diseases sweep through its population as coronary artery disease and cardiovascular disease has become the number one cause of death in Bahamians. And unless people decide to act and change their way of business, they are going to pay a phenomenal price according to cardiothoracic and vascular surgeon Dr. Duane Sands.

"The reality unfortunately is that if we continue to do what we are doing, many of our brothers and sisters, mothers and fathers, aunts and uncles are going to die from cardiovascular disease -- diseases due to hypertension, diabetes, inactivity and just plain being lazy," said Dr. Sands as he spoke on heart disease at the recent Doctors Hospital Distinguished Lecture Series during Heart Month.

"If we believe that it's okay to be overweight, we're kidding ourselves. If you're solid, then the best way to be solid is to carry that solidity in your buttocks or your thighs. If you've got a Coke bottle figure you're all right, but if you carry it in your belly it's very dangerous," he said at the lecture held at Doctors Hospital on Shirley Street. "Unfortunately, we are becoming like our first world brothers and sisters," said Dr. Sands who said that in the developed world, it is ischemic heart disease that is killing people.

"CARICOM, the Pan American Health Organization, the World Health Organization, all acknowledge that The Bahamas and the rest of Latin America are watching a tsunami of chronic non-communicable diseases." The surgeon had the people attending the lecture to stand up and look at the people across the room from them, then told them that they were looking at people who were going to drop dead from heart disease. He told them that in 1990, eight million people in developing countries died of cardiovascular causes and five million died in the developed world.

But in 2020, the projection he said is a disproportionate burden of cardiovascular disease in developing countries like The Bahamas. Frightening According to Dr. Sands, countries in the region have been challenged by crime, underdevelopment, and infectious disease, but have no idea how they're going to deal with the scourge of chronic non-communicable diseases. He said that within the next 15 years or so that medical professionals were going to see a 300 percent increase in deaths from non-communicable diseases

. "This is frightening because no economy in the region is going to be able to handle this," said the doctor. "Unfortunately women are going to pay a disproportionate part of that price -- and particularly black women -- because they are more at risk. Black women tend to be overweight. They tend to have more hypertension and diabetes and tend to be underrepresented and when they talk no one listens to them. When a fellow says he has chest pain everyone gets scared. When a woman talks about chest pain they say she has gas."

The cardiothoracic and vascular surgeon told the lecture series patrons that Bahamians are killing themselves through their own bad choices. "Our ancestors were hunter-gatherers. We've gone from hunting and gathering for the family to the fellow who drives to the fast food checkout or his most significant activity is using the remote control." And he said too many Bahamians believe that if a person is thin that something is wrong with them. "If you were recently married and you sent a fellow back to his Ma and he look like that (slim) she gone tell him 'Son come home cause this gal trying to starve you and kill you.' And if a woman doesn't have li'l meat on her bones we gone say she sick.

How many babies do we see that unless they have five chins and six necks we don't think that they're healthy?" According to Dr. Sands, the destruction of the body begins from the time of birth, from the foods people consume, and their own bodies as only 35 percent of the cholesterol which is a big part of the problem comes from the food consumed. He said 65 percent of cholesterol is made in people's bodies. "We have good cholesterol, HDL, and you can think of it as the police; and bad cholesterol, LDL, you can think of them as the criminals.

Whatever the balance is gives you an idea of your total load of atherosclerosis." He said HDL is higher in women, and goes up with exercise and with alcohol in moderation, which is one drink per day (two drinks per day for men). If the LDL cholesterol is dropped, and the HDL cholesterol increased, he said it is associated with a significant reduction in the risk of heart disease as the blood vessels do not become blocked. He said when the vessels become filled up with cholesterol and calcium then people have a problem.

To get around this Dr. Sands said people have to eat right -- fruits, vegetables and lean meats. "If the bag your food is in has a bunch of grease settling at the bottom, you know it's not good for you. Half your plate should be fruits and vegetables. And you need to exercise. You don't need to go to the gym. You don't need to run the 100-yard dash. You don't need to play tennis. The simplest thing for you to do is walk, but if you want to do those other things that's fine," he said. Know your numbers Dr. Sands encouraged them to know their numbers.

He said their cholesterol should be less than 200; their good cholesterol greater than 40; and their bad cholesterol less than 100. And he said they should have their cholesterol level checked on a regular basis, and that if they reduced their cholesterol by 10 percent, they could reduce their risk of death by 20-30 percent. Dr. Sands also said people should ensure that their blood pressure is controlled. The ideal blood pressure number is 120 over 80. He also encouraged people to lay off the salt, and encouraged diabetics to ensure that they control their blood sugar.

The surgeon gave the Lecture Series participants a sobering statement: "What fits your busy schedule -- exercising for one hour a day or being dead 24 hours a day." When the blood vessels in the heart get blocked, the heart muscle gets deprived of oxygen and food, according to the doctor. He said when these things build up, eventually people get angina -- a crushing chest pain for many people, but which he said can be any pain from the earlobe down to your belly button. He said pain that is also in the shoulders, elbows and fingers could be heart pain.

"For 30 to 35 percent of people the first symptom of heart disease they have is a heart attack and for some of those people the first sign of a heart attack is death, so you may be lucky to get chest pain, but you may not," warned the doctor. And he said that one in 100 kids born in The Bahamas are born with a heart defect. "Some of the things you can change, some you can't. One of the important things for you to do is pick your parents right. If you pick your parents right you straight," he said, which got a chuckle from the audience.

"But if you can't do that you have to control your weight, make sure you're active, know your cholesterol, eat right, control your blood pressure, don't smoke and minimize tension and stress," said Dr. Sands. The first open heart surgery was done at Doctors Hospital in 1994. Dr. Sands said it used to be exciting that people flocked to the room to watch the procedure. With hundreds of surgeries having been done at the facility, Dr. Sands said it's no longer an exciting thing for people to want to watch.

The doctor also reminded the lecture series participants that surgeries for heart disease are expensive and that most people don't have insurance. He said unless people decide to act and change their way of business, Bahamians are going to pay a phenomenal price.

According to Dr. Sands, of the 191 countries in the United Nations (UN) and the World Health Organization, the healthcare status of The Bahamas was ranked 94th in 2000, but Bahamians had one of the worst levels of health in the United Nations at 137th. By comparison, Canadians were 30, United States 37, Cuba 39, Barbados 46, Jamaica 53. And he said this was despite the fact that The Bahamas spend a huge amount of its gross domestic product (GDP) on health.

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