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.

Buckwheat

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.

Oats 

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

GLUTEN GRAINS

 

Wheat

Rye 

Barley

Triticale is a cross between wheat and rye.

Derivatives of wheat that also contain gluten are,

Wheat berries

Durum

Semolina

Spelt or donkey

Farina

Farro

Graham

Kamut. (Khorasan wheat)

Emmer( red wheat)

Freekeh

 Bulgur wheat

Barley 

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

Rye

Is used in breads,cereals,beer

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.

Choline

Choline is an important nutrient that plays critical role inBrain development,cell signaling,nerve impulse transmission,lipid transport and lipid metabolism.

Foods naturally containing choline are,

Chicken livers

Salmon

Eggs

Milk

Almonds

Fall season and soup time

Butternut squash around thus time is available in plenty and I am going to share an easy recipe.

Take butternut squash and cut it in middle and remove the seeds.It can be cooked in oven or on the stove.

To the cooked squash add 1 cup of water,1 cup of coconut milk,2 tablespoonful apple cider vinegar,

Salt and pepper to taste.Add 1 tsf of grated ginger and put it in a blender.

Our soup is ready

Foods and MCI( minimal cognitive impairment)

According to Dr.Dale Bredesen,patients with memory problems should stay away from a triad of 

simple carbohydrates,saturated fats and low fiber.Use meat as a condiment only.

Eat pastured eggs only.eat wild caught fish only.Do not eat fish with big mouths and long lives as they carry a lot of mercury,e.g swordfish,tuna,shark.

Remember Smash fish i.e salmon,mackerel,anchovies,sardines,herring.

Fasting for a minimum of 12 hours a day is great.It should be 12 to 16 hours from the last meal I. The day to first food next day.

Banana tea

How about a better sleep with Banana tea?

I attended a seminar on better sleep without pills.

According to Dr.Breus,a sleep physiologist,who advocates banana tea for his patients for sleep.

As per his advice,you take a banana and remove tips of top and bottom of the banana. 

Leave the peel on the banana.

Boil 2 to 3 cups of water and cut the banana into half with the peel and drop it boiling water and boil for another 3 to 4 minutes till it becomes brown.

Then steep the water into teacup.you can flavour with cinnamon or honey.

The banana peel has very high amounts of magnesium that helps with sleep.

Flavours

How about some quick flavours from around the world!

Jamaican flavour

2tbs onion powder

2 tsf sugar

2 tsf salt

Pinch of thyme

11/2 tsf red pepper flakes

1 tsf black pepper crushed

1/2 tsf allspice

1/2 tsf cinnamon

Chimichurri

1/2 cup olive oil

1/4 cup red wine vinegar

1/2 tsf salt

3 cloves of garlic

1/2 cup parsley

3 Tbsf cilantro

Tandoori

6 oz of yogurt

1/4 cup milk

1 Tbsf lemon juice

1 tsf salt,paprika,sugar

1/2 tsf ground coriander powder

1/2 tsf curry powder

How to bring back gut flora i.e restoring micro biome after antibiotics

Human micro biome is very important to our health.

There is no doubt that antibiotics save lives.

However in doing so they disrupt integrity of normal micro biome.

It is very important to learn how to bring this back.

Viral infections like common cold,bronchitis,sinus infections do not respond to antibiotics.

Use of antibiotics can lead to severe diarrhoea withClostridium difficile.

Another source that affects humans is that antibiotics are fed liberally to animals and sprayed extensively on produce.The trace amounts left on produce is enough to disrupt micro biome.

Even patients receiving IV antibiotics should take probiotics.

Patients who have been on lon term antibiotics show a severe erosion of glycocalyx that coats the intestinal microvilli.This then is associated with loss of brush border and marked reduction of secretory 

IgA.

If a person states they are not tolerating any antibiotics,then it is a red flag that there is some problem with the immunity.

We will start with foods that help restore micro biome.

Fish oil.zinc,colostrum,vitamin A are good first line.

Plant based medicines like

Oregano oil

Tea tree oil

Pau D' arco

Are very good for ridding the body of harmful yeasts.

Do not eat Taxing foods,like wheat,dairy,sugar,fried items.

Peanut allergy

The national institute of allergy and infectious disease has given new guidelines for peanut allergy prevention.

Foods containing peanuts can be introduced into diet of infants 4 to 6 months of age even if they have eczema and or egg allergy.

If infant has mild to moderate eczema,peanut containing foods can be introduced at 6 months of age.

There is a skin prick test for very highly allergic groups where peanut specific IG,Ecan be measured.

If skin prick testing with peanut extract results in a whealof upto 2 mm then risk of allergy is low.

A wheal of 3 to 7 M suggests high risk of allergy.

Special salad

I want to share some ideas about eating salads.

It does not have to be the lettuce head all the time.You can use Romaine lettuce too.

You can steam some root vegetables like a potato,yam,parsnip,carrot,half a beet.

To this add roughly chopped romaine lettuce.sprinlkle some pieces of cashews.

For the dressing,blend together ,1/2 cup of unsweetened almond milk,1/4 cup raw cashews,

Garlic cloves,2 tsf of maple syrup,salt and black pepper to taste,some lime zest,1/2 tablespoon

Of lime or lemon juice.can add chopped parsley or tarragon,add vinegar 1 tsf.

Pistachio Gremolata

Our son went to Rice University and the summer 2017 of Rice magazine was the food issue.

It described pistachio Gremolata.

Gremolata is a chopped herb condiment with chopped parsley,minced garlic,lemon zest ,1 cup pistachio.Salt and pepper to taste.

Eggplant can be prepared in two ways.

The long Japanese eggplant can be sliced in half from the middle and both the open sides of eggplant can be toasted in olive oil on low heat.

Or,the big eggplant can be put on the flame directly till skin is charred and the inside meat of eggplant is hot and watery.

Or the big eggplant can be cooked in microwave and remove skin and make a mush.

Pistachios can be toasted prior to use.

The pistachio gremolata can be served over the cooked eggplant.

To make it even more tasty sauté some onion and tomatoes together and add the eggplant meat which is mushy to this .This version is called Bagan bharta!

Garnish with a dollop of plain yogurt and fresh pomegranate seeds.

Homemade liver cleanse

I bunch of beets

1/2 cucumber

2 cut up sticks of celery

1 lime squeezed completely

1/2 of green apple

1/2 tsf of ginger

Juicing or blending as needed.

Cajun seasoning

This is a basic recipe for Cajun seasoning and can be added to buttermilk.

1 tsf garlic powder

1 tsf onion powder

1 tsf oregano

1 tsf thyme

1 tsf red pepper flakes

1 tsf cayenne pepper flakes

Salt to taste

1 tsf of paprika

Avocado dressing

I love avocados and have experimented a few recipes.

We can use plain yogurt.

If it is thick like Greek yogurt add 5 to 6 tsf of milk

1 ripe avocado,chopped

1/4 tsf chopped cilantro

1/4 tsf minced garlic

Salt and pepper to taste.

Mango tango dressing

This is mango season and a fresh mango salad dressing would be heavenly.

Cut up a ripe mango.

1 cup orange juice

1/4 cup chopped cilantro

1/4 sf fresh minced garlic.

1/2 of lime  squeezed fresh

Salt and pepper to taste

Can add 1 Tbsf of tahini to give thickness

Dressings ( homemade)

Hi friends,

When you make something homemade,you have control over what goes in. Hence we can avoid sugar or oil in large amounts.

Let us start with Thai peanut dressing,

2 tablespoonful,peanut butter

1/4 cup canned coconut milk

2 tsf soy sauce

Brown sugar 2 tsf

I like to add fresh orange juice Instead of sugar.

1/4 tsf of fresh minced garlic

1/2 tsf of fresh grated ginger

2 tsf of chopped cilantro

Just blend together.

Water can be added to make consistency of your choice

Squeeze in 1/2 lime.salt and pepper to taste.

Romanesco cauliflower or broccoli romanesco

Have you seen the different varieties of cauliflower?

The typical yellow or white cauliflower,the green cauliflower or even the purple cauliflower?

I am sharing a recipe with you.

"This is a traditional salad from Naples, known as Insalata di Rinforzo, which is typically served at Christmas time. It's lovely and colorful as it uses cauliflower, lime green Romanesco and dark green broccoli and is jazzed up with olives and red pickled peppers. It is served with a lemon-based vinaigrette and sometimes capers."

One can add to the salad ,honey mustard red onions and lime or lemon

Enjoy!

Plants

It seems I keep emphasising the need to eat more plant food.In the Mind diet,

— a combination of the Mediterranean and DASH diets — published online in Alzheimer’s & Dementia, The Journal of the Alzheimer’s Association in June 2015 — concluded that people who eat more dark, leafy greens at least once a day have substantially slower cognitive decline with age than those who eat the Standard American Diet (SAD). 

It is always about plants,whether it is heart health,longevity,brain health,plant food comes into play.

How do plants help? Imagine looking at your living room and seeing dust bunnies clustered under cabinets and chairs. It happens to the best of us! We accumulate them just from living. In a similar way, we accumulate free radicals in our brains, just from being out in the world. Here’s where cruciferous vegetables come to our aid! They act like vacuum cleaners, sucking up the free radicals, those trouble-makers! It’s all about taking care of your beautiful brain.

Sobremesa

Hi friends,

Have you heard of the term Sobremesa?

It signifies after dinner activities, after lunch or after dinner where people sit and chat,and have coffee

or Tea and just relaxing.

Spices

Use of different fresh herbs and dried ground or whole spices is in all cultures throughout the world.

I am going to share a few different names and constituents of these with you in next few blogs.

I make my morning tea using fresh ginger( grated),fresh mint,lemongrass clippings,and pinch of ground cardamom seeds.

I will share a Lebanese 7 spice seasoning that I got from Salma Hage.

To make about 13/4 cups,

5 Tbsf ground allspice

3 1/2 Tbsf pepper

3 1/2 tbsf ground cinnamon

5 Tbsf ground cloves

4 Tbsf grated nutmeg

4 Tbsf ground fenugreek

4 Tbsf ground ginger.

Usually,1/2 or1 tsf is enough as cloves,cinnamon are strong spices.

Use this in Tabbouleh,Falafel.

Horchata

Do you know what is Horchata?

It is a milk and rice drink popular in Mexico.

In Spanish,it is BebidaDe Leche y Arroz.

You can make a nice smoothie using this drink by using ,

8 oz of Horchata,1/2 banana,1/2 cup of pineapple,ice cubes.

You can add 1/2 cup of washed Swiss chard to make it green.

Delicious!

Enjoy Horchata smoothie.

Advice for patients after bariatric surgery

Eat 3 meals daily without skipping meals.

Portions should be 1/4 to 1/2 cup per meal

Stop eating when full.

Eat nutrient dense food .

Avoid foods high in sugar and fat.

Use less than 3 to 4 gm of sugar per meal.

Have protein with each meal.

Protein powders or nonfat dried milk can be added to meal.

Eat slowly.

Chew foods so they are consistency of applesauce.

No fluid with meals.

Avoid drinking liquids15 minutes before meals and 30 minutes to 60 minutes after meals.

Drink at least 64 ounces of decaffeinated fluids daily.

Avoid alcohol.

Limit fat to 3 GMs of fat for every 100 calories consumed.

This was obtained from the Obesity society and association of clinical endocrinologists.

Capers

Capers are unopened flowering buds of caper plant.

It is a popular Mediterranean spice.

Capers are harvested early in the  morning allowed to wilt in hot sun before storing them in a jar with vinegar, olive oil.

Capers are very special.

They are very rich source of Quercetin.

Quercetin is a bioflavonoid. It helps maintain integrity of blood vessels.

Quercetin is an antioxidant with scavenger like activity for free radicals.

Healthy crunchy salad

The ingredients I would use would be shredded ,

Red cabbage

Green cabbage

Carrots

Beets

Peanuts

Edamame

Avocado small chunks

Savoy cabbage

Thinly sliced red and yellow bell pepper

Spread all this on a bed of rice noodles.

Dressing makes big part of salad.

Ingredients for dressing include

1 tsf miso

1 tablespoonful orange juice

I tbsp tamari

1 tsf shredded ginger

1 tbsp tahini

1 tsf rice vinegar

1 tsf maple syrup

1/2 tsf grated lemon rind

1 tsf lemon or lime juice

Blend or whisk the above

Sea salt can be added for taste

Beet Blood Pressure

Do Beets really lower Blood pressure?

The answer is YES.

Raw beet juice was most effective.

Cooked beets were good too but not as much as raw.

Raw beet juice lowers inflammation,lowers cholesterol too.

They are a dietary source of nitrates which are used o make nitric oxide which is used for dilating arteries.

Beets are high in folate,fiber,manganese,potassium.

Cruciferous vegetables and health

I wanted to share with you that all Cruciferous vegetables have health benefits in preventing heart attack,preventing stroke and helpful in cancer prevention.

What are these vegetables?

They belong to Brassica family .

They include Broccoli,Brussels sprouts,Cauliflower,cabbage,Kale,mustard,radish,rutabaga and many more.

As such if you smell Brussels sprouts,there is no smell but,if you you cook them,the compound glucosinolate is released which gives the particular flavour for the Brussels sprouts.

Roast them in oven for 15 minutes and you have delicious vegetables ready to eat!

More to come on this group.

Anthocyanins

Anthocyanins are antioxidants found naturally in certain foods.They are responsible for the dark purple,red and blue color of fruits and berries and beans and vegetables.

The foods known to be rich in Anthocyanins are,

Blackberries and other berries like strawberries,raspberries,aroniaberries,blueberries,boysenberries,marionberries,elderberries.

I have particular interest in Black raspberries grown in Oregon in July and confer great health benefits.

This chart is from Oregon Raspberry and Blackberry Commission.

ORAC value is a measure of a substances ability to absorb oxygen free radicals.

Oxygen free radicals can damage DNA,cause cellular changes,oxidize LDL cholesterol 

and cause premature aging.

2. Cherries.

Tart cherries have lot more Anthocyanins.

3.Black Currants.

4.Grapes ( skin of grapes)

5.Plums.

6.Pomegranates 

7.Bananas

8.Eggplant

9.Purple red cabbage 

10.Purple Asparagus 

11.Red fleshed Peaches

12.Black Beans and Red Kidney beans.

Supplements that can be beneficial in preventing Breast cancer via modifying estrogen metabolism.

DIM di Indole methane found in garlic and onions

Resveratrol

Alfa lipoic acid ALA

NAC n acetyl cysteine

Iodine

Cruciferous vegetables

Flax seed meal lignans

Folic acid,B6, B12

Milk and meat both have estrogens so reduce consumption.

Soy (not fractionated)

Kudzu

Foods that help fight colds this time of the year

Pumpkin seeds

Pumpkin seeds have lot of zinc which is important for our immune function

Pumpkin seeds can be sprinkled over salads,soups,vegetables.

I have seen roasted spiced pumpkin seeds in stores which have pretty good taste.

Mushrooms

Very good high iron low calorie food.

It's always my choice to add something warm when I am ready to serve my salads.

I sauté the mushrooms in little butter or olive oil and sprinkle over my salads.

I also steam or boil some shelled edamame with some oregano and salt and use it in salads or over vegetables.

Kefir

Kefir is made when milk is fermented by yeasts and lactic acid bacteria.

What is the difference between yogurt and kefir?

Kefir is supposed to have more variety and more number of beneficial bacteria than yogurt.

Both are great foods.

Plain kefir or yogurt is always better than sweetened kefir or yogurt.

Remember this has to do with so called probiotics or good bacteria.

Kiwi fruit

Kiwi has more than a days supply of Vitamin C.

It can reduce severity of upper respiratory infections.

I add kiwi fruit to my green smoothies after peeling the fuzzy skin on outside of the kiwi fruit.

Barley

Barley is a healthy grain.

It had a soluble fibre called beta glucagon which helps in giving anti inflammatory properties to Barley.

I use barley in vegetable soups,or cook it with rice or use cooked barley in salads.

Elderberries 

I have used elderberry cough syrups with very good results.

I tell my patients to use Aroniaberry chews,or use Aroniaberry concentrate in water and drink it when one has cold yo reduce duration.