Please Read This First

In case of an emergency, please call 911 or ambulance or go to the nearest emergency room.

This blog is for information only. Dr. Dave will not respond to comments.

The information you obtain at or this blog is not and not intended to be a medical advice. You should consult a medical doctor for individual advice regarding your health. The use of the Internet for communications with the doctors will not establish any MD-patient relationship and messages containing confidential information, personal health or emergency should not be sent to the website or the blog.

Sunday, December 10, 2017

Is levothyroxine enough for everybody with hypothyroidism?

About 10 to 15% pts on levothyroxine end up still with symptoms of hypothyroidism while taking the medication.
This is because of unmet biological need for T3.
Looking into history,
In 1965, 85% of thyroid prescriptions were for natural thyroid products.
Then came Johnny come lately,Levothyroxine and it was felt there was peripheral conversion of T4 to T3.
T4 replacement suppressed TSH and normalized T4 and T3 levels but at the expense of elevated T4 to T3 ratio.
Other markers for bonfire thyroxine replacement did not suggest correction of lipids,or signs of hypothyroidism.
With elevated T4 to T3 ratio impairs systemic T3 ptoduction by down regulating deiodinase pathway.
With only T4 replacement only,T3 levels do not come to hypothyroid state.
A specific gene in some hypothyroid patientsDIO2, a type 2 iodothronine deiodinase gene improves hypothyroid symptoms with replacement of T 4 And T3.
Dr Gregory W Rutecki M.D at Cleveland clinic wrote this paper.

Grapefruit juice and statins

Grapefruit contains a group of compounds called furanocoumarins.
Once we drink juice,the CYP3A4enzymes start working breaking down the chemicals.
Medications that are broken down by CYP3A4 are Simvastatin,atorvastatin,viagra,cialis,Levitras,coumadin( warfarin),codeine.
Drinking orange juice or water does not affect this enzyme.
A genetic test can be done to see if CYP3A4 is working slow or fast in you.
If the grapefruit juice and the medications listed above are taken at different times atleast 8 to 10 hours apart then it does not matter.
If there are more concerns of medication toxicity with grapefruit juice then reduce the medication dose by half or even you can skip a day of medication.

Grapefruit juice and statins

Many a times a bottle of prescription drugs state"do not eat grapefruit or drink juice when taking this medicine".
The enzyme important in breakdown of a chemical in grapefruit juice is also involved in breakdown of certain drugs.
The molecule called cyP3A4 resides in liver,colon,small intestine.
Thus if cyP3A4 enzymes are preoccupied in breakdown of grapefruit juice you just drank,there will not be enzymes available to breakdown medications.
In 1989,a group of Canadian scientists were studying interactions of ethanol on felodipine taken for high bp.The scientists used grapefruit juice to disguise taste of ethanol and observed differences 
regarding amount of drug in blood stream.It was five times mor in blood stream of people who drank medicine with grapefruit juice compared to when it was taken with water.

Sunday, November 19, 2017


Really Buckwheat is not wheat.
It is the seeds of a flowering plant like quinoa.
It is gluten free.
It is gelatinous when cooked.
It is very useful in Diabetes mellitus in controlling sugars as it is a complex carbohydrate and does not release sugars right away.
The same thing happens to a cooked potato.If a potato is cooked or baked and then stored overnight in refrigerator the next morning it can be consumed by a person with diabetes as it has formed complex carbohydrates.
Toasted buckwheat is called KASHA.
Buckwheat contains Rutin that strengthens capillaries.
Buckwheat in Hindi as KUTTU
Soba noodles are made with buckwheat
Buckwheat has plant lignans which are converted by the friendly gut flora into products that protect against cancer.
Buckwheat is derived from a Dutch word bockweit meaning beechwheat.
It reflects the beech nut shape.
It has a lot of insoluble fiber so it prevents gall stones.

Gluten grains

Gluten of wheat is used in breads,baked goods,pasta,soups,cereals,salad dressings.

Is traditionally not gluten free because of crop contamination between wheat and oats.
However,if oats has the label of gluten free then they are gluten free because of how they are cultivated.

What are groats?
Groats are Ny grains that are minimally processed to remove its outer husk or hull called chaff.
Grits retain germ and bran
Steel cut oats are oat groats that have been cut into small pieces.

Bulgur wheat is a heat grain that is toasted and cracked.

Freekeh is a young green wheat that is toasted and cracked.

Farro is a specific wheat that is chewy when cooked

Grains gluten free and gluten containing

Triticale is a cross between wheat and rye.

Derivatives of wheat that also contain gluten are,

Wheat berries
Spelt or donkey
Kamut. (Khorasan wheat)
Emmer( red wheat)
 Bulgur wheat

Is used in malts,food coloring,soup, beer,Brewers yeast.

Is used in breads,cereals,beer

Sunday, October 22, 2017

Botanical gel for viral warts

A botanical blend from Aviratek biomedical solutions ( Phoenix,Arizona) containing,
Hypericum perforatum 2.5%
Lavandula officianalis 10%
Glycarrhiza Galbraith 2.5 %
Melissa officinalis 6%
Eulethrococcus senticosus 4%
Sarracenia25% ( mixed species)
In a gel suspension matrix.
The gel formation also has allantoin,glycerin that help skin healing.