Liver fluke Cancer a warning

[Khun Paul]

I saw that and I thouight I know some foreignes that love this, a warning for all and their Thai families I think.

Deadly dish: the dinner that can give you cancer
By Jonathan Head
South East Asia correspondent

Jonathan Head reports on the raw fish that can cause liver cancer
Health Check


A local delicacy in north-east Thailand, made from raw fish, has been found to be behind a high incidence of liver cancer in the area, and doctors are trying to educate people about the risk.
The Isaan plateau of north-eastern Thailand is poor, dry, and far from the sea. Home to around one third of the country's population, most of them ethnic Lao in origin, it is renowned for its spicy and inventive cuisine, using whatever ingredients are available.
Where there are rivers or lakes, they use the smaller fish they catch in a pungent dish called koi plaa. The fish are chopped up finely, and mixed by hand with local herbs, lime juice and live red ants, and served up raw.
It is very popular, but also dangerous.
For decades, certain populations in the north-east have been known to have abnormally high levels of liver cancer.
In men it comprises more than half of all cancer cases, compared to an average of less than 10% worldwide.
The high prevalence has long been linked to infection by liver flukes, a kind of parasite, found in raw fish.
But it is only in the last decade that a serious effort has been made to get people to change their eating habits, by cooking koi plaa to kill the flukes before they eat it.
Fluke infestation

Liver fluke eggs are excreted into the water system by infected people.
Dr. Banchob Sripa at the Tropical Disease Research Laboratory in Khon Kaen University is the man largely responsible for this effort.
"We have been studying this link in our labs for over 30 years", he said.
"We found that the liver fluke can make a chemical that stimulates a host immune response - inflammation - and after many years, this becomes chronic inflammation, which then becomes cancer."
His team found that in some communities up to 80% of people were inflected by the fluke, some as young as four years-old, but that the cancer rarely developed before people reached 50. Once it does, though, there is little hope for patients.
At the university hospital they receive around 2,000 patients a year with a specific form of liver cancer called cholangiocarcinoma.
Only around 200 of those can be treated, usually by surgery, cutting out the tumour from the liver.
The others are given palliative care, easing their discomfort, usually by draining bile ducts, until they die.
The only effective remedy is prevention.
So Dr. Banchob and his team are running a community-based health education programme in the villages along the great wetland, known as Lawa Lake, south of Khon Kaen, where liver fluke infection rates are highest.
Changing perceptions
Education is helping the next generation to learn about the dangers of raw fish
They started by using the most effective methods for this region; recruiting respected community leaders to do most of the talking, and injecting plenty of north-eastern music and humour, which can be as pungent as the local cooking.
They have composed songs that press home easily understood information about the life-cycle of the fluke.
The larvae, embedded in the fish's flesh, are consumed and grow into an adult flukes inside the liver.
The eggs are then excreted, passing back into the water system where they are eaten by a particular snail, before the larvae move back to the fish again.
They also take a portable ultrasound machine around the villages to screen people for liver fluke infection.
It is striking how many older people have high levels, indicating that they still eat their koi plaa raw.
"Sometimes I cook it, but sometimes I forget," said 61-year-old Jongluck Laonongkwa after his screening. His liver was infested with flukes.

Although liver fluke infestation can start young, liver cancer usually appears in later life.
"I think 60% do understand the causes of the liver cancer" said Dr. Banchob, "they are aware of the liver fluke.
"But 10% are still eating raw fish. I believe that 10% probably cannot change. So we should change the environment, make the fish cleaner, to get fewer infections."
Part of the education campaign focuses on getting people to use proper toilets, and not defecate in the lake, which reduces the number of fluke eggs.
In the villages where the campaign has been running, infection rates are coming down sharply, to below 10% in some.
It will take more time for liver cancer rates to fall significantly, but the attitude of younger people is encouraging.

They understood all too well that the risk of ending up like her father was not worth it.

[monkeyman]

Good post Paul, anyone that has lived here for a considerable time will have seen many die of this desease, they are dropping like flys in the village next to me with a new funeral nearly every day

But 2 months ago it hit home hard for us too when my sister in law went for a general check up thinking she just had digestion problems, she was screened and the flukes were in her vital organs.. once you get the 1st (any) symptoms it is then to late and she was told there was nothing they could do and she had to just go home and wait to die... the cancer / parasite works very fast and sadly only within 2 weeks she was dead

My good friends mother in law is seriously ill with it and not expected to last too long,,,, there was even a story ( I think on here ) of 3 young American tourists which went eating ' like the Thais' in the villages and contracted it....

It is not just in the fish but the unfermented sauce which is kept in old jars which can be riddled with the parasite...

Most Thais are uneducated about this but some are prepared to still take the risk as it does not taste the same if cooked properly

But this post is well worth while if there are any unaware falaangs out there that can maybe save the life of a loved one in their family ....
..

[Drunk Monkey]

Yes a very long and eye opening piece on BBC World this morning ,,Jonathan Head in Khon Kaen .

Closer to home Monkeymans personal family experience serves as areal warning.

DM

[MrFixer]

It pays to take a yearly dose of antiparasitic. Only about THB50.

[MrFixer]

Praziquantel 40mg/kg as a single dose.

[Khun Paul]

If you cook your food and do not take unnecessary risks with your food, there is no need to take anything at all, after 12 years I do not take ANY medication but then I eat what I like from where I like providing it is cooked well in a clean kitchen, I'd rather go hungry than eat 3/4 rs of the rubbish Thais eat... Sorry but there it is.

[GT93]

We could probably say the same about English and New Zealand eating habits and improve our health - don't eat 3/4 s of it.

Presumably you don't include fruit in your rule KP. I think Thailand is great for fruit.

[Drunk Monkey]

If you cook your food and do not take unnecessary risks with your food, there is no need to take anything at all, after 12 years I do not take ANY medication but then I eat what I like from where I like providing it is cooked well in a clean kitchen, I'd rather go hungry than eat 3/4 rs of the rubbish Thais eat... Sorry but there it is.

I think its un fair to say that Thais eat rubbish KP ... most of the patients in the BBC piece were old 60 / 70 onwards and un educated as to the health risks some were addicted to the food ,,, younger Thais are fortunately being made aware of the dangers and in turn eating differently ..i love Thai food including the rural Isaan style with all its strangeness but i have now stopped eating this river fish and also dishes like Goy for instance which is bascially raw meat in lime juice which is supposed to cook it

With enough publicity and education in time this can be eradicated ...but for some its too late as the film showed .

DM

[monkeyman]

I might ad a small disturbing point, my sister in law (just 48) and family were only told she had cancer and it was inoperable, and thats it! there was no mention or advise given to them how the cancer had been caused, it was only after I read her report and googled cholangiocarcinoma that my suspicians were confirmed....

[747man]

I've TOLD My Mrs She cannot even have that koi plaa stuff in the house.......Besides anything else it FOOKIN' STINKS....

[Khun Paul]

I was informed when I came here some 12 years ago, never eat anything from a stall, a Thai told me that and I have never strayed from that advice at anytime.

[GT93]

I've TOLD My Mrs She cannot even have that koi plaa stuff in the house.......Besides anything else it FOOKIN' STINKS....

Ah, the Mrs. is mentioned. That will hurt the ugliest rumours.

I have a Thai employee in NZ and the kitchen area of the office frequently stinks after she has used the microwave. I try to have lunch first.

[Shado]

I've TOLD My Mrs She cannot even have that koi plaa stuff in the house.......Besides anything else it FOOKIN' STINKS....

No it doesn't. Koi plaa (ก้อยปลา) is a raw fish salad. Sometimes raw shrimp is used, koi goong (ก้อยกุ้ง). It smells quite fresh and nice. Perhaps you are thinking of pla ra (ปลาร้า).

[waanjai]

Udon Thani has highest rate of liver-fluke cancer in world

An earlier report about the topic contains some hints for prevention:

http://koratfart.com/health-care-in-tha ... eb#msg4997

The risk factors:
(1)The chief culprit is a microscopic parasite called "opisthorchiasis viverrini", which becomes imbedded in the liver after victims consume raw fish from rice fields and ponds. The parasite, however, is not found in seawater fish.
This concerns the direct consumption of sweetwater fish out of the ricefields. You have to boil/cook it.

(2) Another culprit linked to this cancer is "Nitosamine", a carcinogenic agent directly involved in causing cancer.
Nitosamine is commonly found in fermented fish sauce and fermented proteins and pickled fish and meats.
"To make fermented fish sauce safe, all you have to do is boil it," says Bancha. "But not all sellers do this."
Since years I eat naam pla raa - but only as it was cooked during destillation.

[thaiguzzi]

I was informed when I came here some 12 years ago, never eat anything from a stall, a Thai told me that and I have never strayed from that advice at anytime.

I'd say you've missed out on a damn lot of fine, tasty food then.
A good Gai Yang, Somtam, Kao Neow (chicken, papaya salad, sticky rice) stall with iced water FOC on the side is a damn fine lunch, on the side of the road. I could go on, the list is endless, but i'm preaching to somebody who's mind is obviously made up, 12 years ago.

[747man]

I've TOLD My Mrs She cannot even have that koi plaa stuff in the house.......Besides anything else it FOOKIN' STINKS....

No it doesn't. Koi plaa (ก้อยปลา) is a raw fish salad. Sometimes raw shrimp is used, koi goong (ก้อยกุ้ง). It smells quite fresh and nice. Perhaps you are thinking of pla ra (ปลาร้า).

Apologies Shads.....Pla Ra it IS Mate.....Smells worse than an Arabs Wellies in Doha at 47c......

[waanjai]

But You all like the naam pla that is commercially produced from saltwater fish (and similar) and is used with almost all Thai dishes?

[747man]

But You all like the naam pla that is commercially produced from saltwater fish (and similar) and is used with almost all Thai dishes?

Yeah !! But it does'nt STINK.......

[waanjai]

Yeah !! But it does'nt STINK.......

Its stinks when You have the chance to look at the interim product "fermented fish or fish in fermentation" only. When the Isaan style of fish sauce (based on sweatwater fish) is produced a somewhat pasty mass = plaa raa emerges and can be seen at home. This pasty mass has a very strong aroma, agreed. This pasty mass is further processed to a liquid.

Once the fish sauce has been distilled and filled up with water this heavy aroma disappears. This is the situation when the fish sauce arrives filled up in bottles for kitchen use. Holds true for commercially produced fish sauce (Rayong is a center for this) You get in the supermarkets or the Isaan style of fish sauce You get in bottles on the local markets.

The early form of later fish sauce stinks everywhere. Whether at home in isaan, in small businesses in central Thailand:

https://www.youtube.com/watch?v=bP-yrM5GqHc
or in large fermentation tanks in Rayong:

The whole process takes place in the open air. I quess You now know why.