Northeastern Thais Found With World's Highest Rate Of Liver And Bile Duct Cancer

[Lite Beer]

Northeastern Thais found with world's highest rate of liver and bile duct cancer

BANGKOK, Feb 11 - Northeastern Thais were found with the world's highest rate of liver and bile duct cancer, according to deputy public health minister Surawit Konsomboon.

He said the rate of liver and bile duct cancer countrywide was discovered in 10-20 out of 100,000 persons on average, while only 1-2 persons occurrences were reported from the same sample population size worldwide.

In Thailand's northeast, the rate of this type of cancer is more pronounced, as it was found in as many as 40 people out of 100,000, while among those aged over 40 years the rate of disease was as high as 80 out of 100,000 persons.

A main factor contributing to liver and bile duct cancer is the consumption of partially-cooked fish with scales.

The deputy public health minister said he will propose this issue to the government as part of the national agenda for northeastern Thais.

The matter was on the table for discussion within the Education Ministry, so that prevention of the disease can be made part of the curriculum in primary and secondary schools.

Seminars and training with cancer experts will be made available to public health volunteers for further understanding to the public. Local hospitals are to be supported with new digital ultrasound machines along with training of nurses for quicker diagnoses and more timely responses by medical doctors in the field. (MCOT online news)

-- TNA 2012-02-11

[cardholder]

That's it - the Bplah Rah is going in the bin !!

[borisloosebrain]

I would have thought it's got more to do with excessive alcohol consumption and fatty foods.

[slapout]

Wonder who made the study, over what period of time and the total cancer patients involved? The numbers used as comparsion are just as suspect as the wold average used. A 100 % change in numbers on the low end (world average), upward to the Thai figures thrown out.

[hyperdimension]

What about the Japanese who eat sushi and sashimi? I eat sashimi quite often.

[katana]

Apparently the pla rah can contain liver flukes which are implicated in liver cancer.

http://tdr.kku.ac.th/site_data/tdr_www/OV-CCA_PLoS_Med_July07.pdf

[barrybankruad]

I should imagine (if the figures are correct) that it is a combination of both plaa raa and lao khow.

[TheWalkingMan]

What about the Japanese who eat sushi and sashimi? I eat sashimi quite often.

Not sure, but I think because generally sushi and sashimi are salt water fish which do not contain liver flukes. I could be wrong.

[supaprik]

What about the Japanese who eat sushi and sashimi? I eat sashimi quite often.

Does your sushi also have scales?

[sinbin]

This is old news and first reported in 2010 by the Bangkok Post. The high rate of problems associated with the fluke has been known since 1953. Unfortunately you can't educate those that don't wish to be educated. I've even seen a doctor from my local hospital buy the plaa raa.

http://en.wikipedia....Opisthorchiasis

Edited February 12, 2012 by sinbin

[elwood]

At my advanced age, a rate of 0.08% isn't likely to get me to change any eating habits - should think I have more chance of kicking the bucket on my motorbike.

[SantiSuk]

Don't eat Som Tam (Palaar version) or Laarp Bplaa

I had the liver fluke parasite from uncooked fish a couple of years ago. Not pleasant - recurring flash fevers and lethargy - finally diagnosed by infectious disease specialists at St James Hospital in Leeds UK, having been dismissed as some sort of stomach bacteria by a Pattaya hospital (maybe they don't see it so often as doctors around here in SiSaket). The large regional UK hospital had never seen it before and were fascinated never having seen someone with so many liver lesions and such a high white cell blood count! It was finally the London Hospital for Tropical Diseases that confirmed the diagnosis for St Jimmys.

Local Thai doctors told me when I got back here that the disease (Opisthorcis Viverrini) is so endemic in Isaan that some municipal authorities dose the city water supplies with the treatment drug.

Once identified it is easy to treat and you recover fast. If you leave it untreated, as many poor rural issanners do, you will eventually start to feel better but the parasite can return in later life to give you liver or bile duct cancer.

I no longer eat som tam palaar (the rotten fish in palaar is a known host of the parasite) or laarp bplaa made from uncooked fish. Neither should you guys!

[kiteman9]

I read it's a mold that forms on rice stored improperly.

[Thaddeus]

I read it's a mold that forms on rice stored improperly.

Such wisdom should not go unquoted.

[Briggsy]

Last week I asked at one of the (multinational) firms I am working at where a certain employee had disappeared to. "He's dead," was the reply.

I was surprised as he was a young man of 29 and said, "Was it a motorcycle accident?" "No, liver cancer."

Diagnosis to death in 6 weeks.

[katana]

Don't eat Som Tam (Palaar version) or Laarp Bplaa

I had the liver fluke parasite from uncooked fish a couple of years ago...

Wow, bad story. Good you got it diagnosed and treated. Guess it might be hard to diagnose, especially in the UK, since it's not native to those parts.

[TheWalkingMan]

This is really a heads up for anyone with a partner who enjoys this food. Get them tested now.

[Semper]

What about the Japanese who eat sushi and sashimi? I eat sashimi quite often.

Yes, but does it smell anything like pla rah (sp) ?

[hyperdimension]

What about the Japanese who eat sushi and sashimi? I eat sashimi quite often.

Does your sushi also have scales?

I don't think it's the scales that are the problem.

I no longer eat som tam palaar (the rotten fish in palaar is a known host of the parasite) or laarp bplaa made from uncooked fish. Neither should you guys!

So is it the uncooked rotten fish that the Isaan people eat that increases the risk of liver and bile duct cancer, whereas uncooked fresh fish like sashimi is OK? I think this distinction between the different kinds of uncooked fish has not been sufficiently highlighted.

Edited February 16, 2012 by hyperdimension

[hyperdimension]

Don't eat Som Tam (Palaar version) or Laarp Bplaa

What do these actually look like?

[Semper]

This is really a heads up for anyone with a partner who enjoys this food. Get them tested now.

And shange the ownership of any valuables to your name.

[SantiSuk]

What about the Japanese who eat sushi and sashimi? I eat sashimi quite often.

Does your sushi also have scales?

I don't think it's the scales that are the problem.

I no longer eat som tam palaar (the rotten fish in palaar is a known host of the parasite) or laarp bplaa made from uncooked fish. Neither should you guys!

So is it the uncooked rotten fish that the Isaan people eat that increases the risk of liver and bile duct cancer, whereas uncooked fresh fish like sashimi is OK? I think this distinction between the different kinds of uncooked fish has not been sufficiently highlighted.

Not necessarily - laarp bplaa is made with uncooked fish - usually the various varieties of small fishes netted out of the rice paddies, streams and storage reservoirs in the latter months of the rainy season. I was told that this was equally suspect. The flukes come form the location of the fish - fresh water close to buffalo shit etc. Sashimi fish is largely sea fish and sea fish don't have the same fluke problem.

Som tam is the cold salad made typically of shredded green mango with loads of chillis and lemons and often with a smashed up small land crab in it. The revered variety in Issaan is som tam palaar which is flavoured with rotten fish - you can smell its pungent odour a mile off. There are many other varieties you can eat with impunity - eg dam_n Thai, made with shredded green mango, chilli, lemon juice, peanuts and palm sugar.

Laarp means salad in Lao language (I think). You can get many varieties of laarp - duck, chicken and pork are my favourites. Cooked fish laarp is also fine - just make sure that they have cooked the fish or avoid all fish varieties. Laarp is distinguished by the roasted nutty taste of ground roasted sticky rice grains and its flavouring that typically involves lots of mint and shallots (scallions in American!).

I'll post pictures if you like when I next go round the mother-in-laws to eat, but I'm sure googling the recipes will bring em up.

[MrRed]

Don't eat Som Tam (Palaar version) or Laarp Bplaa

What do these actually look like?

If you have been living in Issan and don't know what somtam looks like......you are a better man than me.

Somtam Pla ra

Somtam Thai is without the dreaded Pla ra and is lighter in colour!

Laarb pla minced up fish cooked/uncooked with palaa fish guts sauce...sep der!!!

Edited February 16, 2012 by MrRed

[Briggsy]

To correct some errors here

The life cycle of the fluke is:- specific kinds of snails ---> specific kinds of fish -----> mammals -----> mammal faeces -----> and repeat.

You need to live in an area which has the specific kinds of snails and fish this fluke can exist in. Then, you need to eat the specific types of fish, uncooked, and with some of skin or scales to become infected. This is because cooking kills the flukes and the flukes are present in the fish's skin or scales not its meat.

Laap just means 'minced' or 'finely chopped'.

[galvheim]

So exactly what do you go ask your doctor to screen for, and what is the treatment (I.e: medicine name)? I have been eating this a long time and my wife and kids too. Would be good to clear this.

[SantiSuk]

So exactly what do you go ask your doctor to screen for, and what is the treatment (I.e: medicine name)? I have been eating this a long time and my wife and kids too. Would be good to clear this.

Google is your friend - eg

"What happens if you get it?

Infected persons may present with mild symptoms of general malaise to abdominal distress, epigastric pain, (I got all those plus moderate fevers recurring two times a day - felt like $hite) and eventually cholangiocarcinoma (liver cancer), especially when the infection becomes heavy and long standing.

How is it treated?

Treatment with the drug Praziquantiel has been reported as extremely effective with a single dose. Disturbingly though, use of Praziquantiel has not been associated with a decrease in cholangiocarcinoma. This indicates that infection must be entirely avoided to prevent a future diagnosis of cancer."

It was Praziquantel that cured me (of everything other than the potential for liver cancer later - the doctors told me that early treatment much reduces the likelihood though). I had to wait 2 days while the drug was shipped form Novartis in Switzerland - the only place with stocks in Europe. It's in most large pharmacies in Issaan I believe.

A doctor would identify it with blood tests (to identify that you have an infection) followed by stool tests {to identify the nature of the parasite - but they do not show up in the stool until a few weeks after infection} in combination with a scan of your liver (the same hand scan they give pregnant mothers).

I guess you could go into any large hospital clinic in Issaan and ask to be tested, but they might look askance if you don't have any symptoms!

{E&OE - I'm not a doctor - just a former sufferer}

Edited February 17, 2012 by SantiSuk

[galvheim]

{E&OE - I'm not a doctor - just a former sufferer}

Still very informative! Thanks a lot! Highly appreciated!

[hyperdimension]

Thanks guys for all the information. The original article was unclear and left a lot of questions.

I live in Bangkok and haven't seen these dishes before, even in the Isaan restaurants, so it's good to be able to recognize them if I ever do come across them in future.

[AYJAYDEE]

i would think they way they soak themselves inherbicides and pesticides might have someting to do with it

[galvheim]

It's of course multifaceted and as you say the way they work in the fields with herbicides is not healthy.

Also that they think asbestos is stone and let themselves soak in dust while cutting it with their anglegrinder is also showing how little health awareness there is.