Tiny Habits

Did u know it is easy to add a small change in your daily routine than to add a big change.

For my patients who are primarily eating meat,all kinds of meat ,no matter how much you tell them about incidence of heart problems or increased incidence of Diabetes because of their eating habits,no dietary modification happens.However if you work with them of cutting down one day a week and make the platter 3/4 full of greens and vegetables,they find it easy to follow.

Advising them to add an apple a day or 7 grapes a day may be easier than just telling them increase your fruit and vegetable intake.This tiny change will be followed and in most cases reported to you next visit.

In some states in USA,there is something called National Produce prescription with a website.

Info@nationalproduceprescription.org

Diet and Lifestyle modification is the only way to reduce incidence of chronic diseases.

King of spices Turmeric

 I had to start with Turmeric!The yellow spice which is getting so popular.

The active ingredient of turmeric is curcumin.

It is said that addition of black pepper to turmeric improves its efficacy multicoloured.

Turmeric is anti inflammatory.As we know every illness is inflammation in one form or the other.

Turmeric and more specifically curcumin has anti Cancer properties too.

Turmeric has been used mixed with milk or cream applied on the face for healthy skin.

Hot fomentation with turmeric powder over a boil or inflamed joint is a household remedy in certain Asian cultures.

Most recently,as the corona virus pandemic knows no bounds,we at home drink warm water to which

we add 1/2 to 1 tsf of freshly crushed ginger and 1/2 to 1 tsp of freshly grated turmeric root.A teaspoonful of honey can be added to the water if u find it bitter.

The question I get asked is which is better to take? Turmeric or curcumin.

My answer is any form of turmeric will do good to you but the extracted curcumin does great .

Just remember Turmeric is grown as a root,like  ginger and is now available in all grocery stores like Kroger ,HEB,whole foods.It is available in organic non Gmo,and regular forms.

Part 2 of restoring micro biome after antibiotics

Foods that help restore micro biome include,

Organic stewed apples,cooked until soft,shimmery.

The pectin released after cooking apples is a good food for bacteria in the gut.

Pectin can help heal damaged intestinal linings,seals off tears in leaky gut.

Collagen helps seal leaky gut.

Chicken bone broth also provides collagen ,like prebiotic.

Butyrate from Ghee is very good healer.

Bananas,sweet potatoes,tubers provide insoluble fiber.

Fermented unpasteurised vegetables like sauerkraut,kimchi,fermented beets are helpful.

Patients who have been on long term or multiple courses of antibiotics have lot of candida in gut.

Fungal infections are accompanied by low IgAproduction as candida consumes glycocalyx and

Secretory IgA as fuels.

Chronic urinary tract infections,thrush are red flags for low IgA.

Lactobacillus and bifidobacilli suffer in gut and can't multiply.

So in these cases you need a resistant yeast called Saccharomycesbboulardii,an antibiotic resistant and probiotic yeast isolated from Lychee fruit in china.

This S boulardii is a potent inducer of glycocalyx production and IgA secretion.

This S boulardii causes physical evacuation of candida.

It is specifically active against 7 out of 8 pathogenic yeast species except C tropicalis.

Think of antibiotics as hurricane and S boulardii as the contractor that comes in to repair damage.

S boulardii is very safe.

True contraindication is true IgE mediated reactions to yeasts.

Spices and curries

Spices have a definite role in improving health.

It is not just a flavor when you add spices to food.

I will give a rundown of different spices and their health benefits.

Creating a curry is usually a mix of different spices,mostly fresh ground then mixed with water,or lemon or lime juice,or coconut milk or yogurt or sour cream or tomato sauce or a mix of tomato paste and tomato sauce or with a sautéed mix of yellow onion,fresh garlic, ginger and green chilies.I still remember my mom grinding various spices and the fragrance of fresh ground spices still is in my memory.I remember my mom and my brother making a huge pot of mixed vegetables as an offering and remembering Mother Goddess.Now,this mixed vegetable was not just the mixed vegetable packets we see in the stores.It included all vegetables that were harvested for that season and included root vegetables like potato,sweet potato,Suran,Ratalu,peas,green beans,onion,garlic,eggplant,cauliflower,spinach and more .The spices are sautéed in oil or Ghee and then the vegetables that are cut in medium size pieces are added and pressure cooked.Did u know they also used dried pomegranate kernels that were dried and ground to a powder and Aamchur,which is powdered dried mango.

Oh! Do I remember the tender baby eggplants being cooked with all spices but no garlic or onion.It reminds me of visiting the Swaminarayan BAPS temple in Houston and Watching the holy saints follow the tradition of Lord Swaminarayan of cooking tender baby eggplants.I follow some well known Dietitions like Rebecca Katz ,chef AJ,or nutmeg notebook couple or the Minimalist Baker,our own physician colleague and Chef John La PumaMD.           .

These are just a few to name but everybody has added more to my desire to write and share it with my patients.

What nutrients can help with diabetic neuropathy

To male it simple,
1. Omega3 fatty acids
2. VitaminD
3.curcumin
4.Alfa Lipoic Acid   600 mg per day
5.Folic Acid
6.Acetyl L Carnitine. 1500 to 3000 mg per day
7.Benfotiamine

Benfotiamine is the fat soluble form of vitamin B1 Thiamine

Covid-19 Pandemic Times

As a physician I always wondered who would diagnose the first ever patient in USA with this Covid-19.

New England Journal of Medicine (NEJM) published the first case details on March 3^rd, 2020.

It reads,” an outbreak of novel Corona virus (2019-nCOV) that began in Wuhan, China has spread rapidly with cases confirmed in multiple countries. The case highlights the importance of close coordination between clinician and public health authorities at local, state, federal levels as well as need for rapid dissemination of clinical information related to the case of patients with this emerging infection.

Just to get timelines straight, China reported on 12/31/19 a cluster of Pneumonia cases in relation to

Seafood wholesale market, Wuhan, Hubei Province.

On January 7^th, 2020 Chinese health authorities confirmed this cluster was associated with novel corona virus (2019-nCOV).

On January 19th, 2020, a 35 year old man presented to an urgent care clinic in Snowhomish county, Washington with 4 day history of cough and fever. He did disclose that he had returned from Wuhan after a family visit on January 15th, 2020.

The patient had seen a health alert from CDC about novel corona virus outbreak in China and as he was running fever and cough decided to get checked. He was checked for flu and culture of all respiratory viruses and they were normal.

Washington Dept of health notified CDC emergency operations center and specimens of nasopharyngeal and oral and blood collected and on Jan 20,2020 CDC confirmed the case as of novel corona virus.

He was admitted to Providence regional medical center in isolation for further observation and care.

He had mild symptoms initially but progressed.

He progressed with vomiting and diarrhea and stool cultures positive for corona.

On Day 9th of his illness he developed pneumonia and dropped oxygen concentrations to 90%.

He was initially treated with IV antibiotics as a hospital acquired pneumonia but quickly discontinued and started on Remdesivir. He improved with care and was discharged.

He was in Wuhan but did not visit the Wuhan seafood market.

Right now, everyone everywhere in the world has been in protection mode to some extent.

We have started social distancing, frequent hand washing, wearing a masks, healthy diet, exercise, and good sleeping habits. Human health depends on healthy ecosystem.

- a tiny video of the precautions to take during Covid-19.

Dharmo Rakshati Rakshita  

                 

A line from Manusmriti says “Dharma protects its protector.”

On similar grounds, the Ministry of environment and Forestry of India, put out their motto as

Prakriti Rakshati Rakshita meaning “Nature protects its protector.”

Science is not political. It pursues truth. A wide majority of new infectious diseases in people come from animals, from wildlife and livestock.

The notion to choose between climate and economy is weird.

There is something called planetary consciousness, meaning taking a holistic view of public health, that includes health of natural environment.

Man clears forests, removes habitats, brings wild animals close to human settlements.

Hunting and selling wildlife are a common sport. This does increase risk of transmission from animals to human.

Have we not heard of HIV, Ebola, Zika, SARS, MERS, and bird flu?

To end my blog,

I am reminded of William Wordsworth’s poem,

I Wandered Lonely as a Cloud.

The words in part are,

I wandered lonely as a cloud

That floats on high o’er vale’s and hills,

When all at once I saw a crowd,

A host, of golden daffodils.

Besides the lake, beneath the trees,

Fluttering and dancing in the breeze.

For oft, when on my couch I lie

In vacant or in pensive mood,

They flash upon that inward eye

Which is the bliss of solitude

And then my heart with pleasure fills,

And dances with the daffodils.

Believe in God.

With Him nothing is impossible.

Happiness is like the lost remote control that you are looking everywhere to find out you were just sitting on it.

-        By Nalini Dave, MD

Stem cells

Almost all cancers arise in organs and tissues containing cells that have the ability, for the lifetime of the organism to replicate in order to maintain and replace cells that are lost because of aging or  damage.

The entire lining of gut is replaced every 7 days.

The skin epithelium is replaced once a month.

Healing damaged tissue with use of large number of un damaged cells seems to be he most efficient mechanism of repair.

However tissues in which cancers usually arise eg skin,mammary glands,gut,brain and blood ,only a minority population of stem cells maintains and repairs the tissue,where as the most replication competent cells have a limited life span.

Green detox smoothie

With the NewYear,the word detox is all over.

I am going to be giving you 3 different detox smoothies.

Let's get started,

I am not going to give you proportions in exact amounts as it does not work that way.

We can use base as water or coconut water.

Next ,to the coconut water in the blender add 1/2 cup of blueberries,

Handful of cilantro and a handful of parsley.

Add 1/2 of a green apple

Add a tsf of chia seeds.

Add a cupful of baby greens packet that are sold in grocery stores.

Home made dressing

In the previous blog,I had used soy sauce but if allergic,one can use Tamari.

Maple syrup and lime juice can be used to make consistency thinner.

I have a good recipe for Tofu marinade!

The previous dressing we made that had Asian flair,marinate tofu in that and then add corn starch.

Tofu is ready to be pan fried.

Home made salad dressings

I hate to get into exact measurements as one cannot think independently of the taste.

This dressing has a Asian flavour.

Mix sesame oil,soy sauce,brown sugar,chilli garlic Sambal,almond butter 

Mix the above thoroughly and use as a dressing.

Add water if too thick or mix of lemon juice and water to make it thinner.

Cannabis ( continued)

Delta9- tetrahydrocannabinol is the primary psychoactive constituent of cannabis and acts as agonists at both CB1 and CB 2 receptors.

It activates presynapticCB1 receptors decreasing cyclic AMP synthesis with downstream functional effects resulting in reduced neurotransmission.

Clinically the effects observed are impaired learning,memory,spatial orientation and attention during cannabis intoxication.

Delta 9 THC can cause tachycardia,low BP,dry mouth and dry eyes.

It's use does not result in respiratory depression observed with benzodiazepine or opioids administration as CB 1 receptors are not found in medullary respiratory centres.

Delta9 THC exhibits both analgesic and anti inflammatory properties.

CannabidiolCBD lacks the intoxicating properties or the high of THC.

It demonstrates weak affinity for CB1 and CB2 receptors.CBD may have indirect effects at CB1 receptors but not with CB 2.

CBD has ANticonvulsant,anti anxiety,anti inflammatory and heuroprotective properties.

The presence of CBD product in Cannabis is believed to moderate or counteract psychosis inducing effects of THC.

Other names of mine phytocannabinoids are,

Cannabigerol has antibacterial properties.

Tetrahydrocannabivarin has antiepileptic effects.

Synthetic Cannabinoids

Dronabinol,identical to THC 

Na lions,a THC analogue

These have been used for nausea,vomitting,appetite stimulation,pain,spasticity.

Recreational use of illegally synthesised cannabinoid receptor agonists are sold in the market as Black Mamba,crazy clown,K-2,spice

These agents of abuse are associated with psychosis,agitation,vomitting and death.

List of conditions for which medical cannabis is used are,

1.Alzeimers

2. ALS

3.cachexia

4.cancer

5.Crohns disease

6.seizures and epilepsy

7. Glaucoma

8. HepatitisC

9.AIDS

10.MS to reduce spasticity

11. Chronic pain

12.Nausea

13. PTSD

I want to thank Mayo clinic for educating us with authentic information about medical cannabis.

Cannabis

Cannabis is classified as Medical or Recreational.

Now we will discuss about Medical Cannabis or Medical marihuana.

It is a group of pharmacological agents derived from subspecies of flowering plant genus cannabis .

It is used with intent of alleviating a symptom or a condition.

Medical Cannabis can be delivered in a variety of ways e.g inhaled,swallowed,topical application to skin or bu cal mucosa.

DEA calls it Schedule1 drug.

Currently 30 states and District of Columbia have programs authorizing cannabis use for medical conditions.

As Cannabis is illegal under federal law,clinicians cannot prescribe it and pharmacies cannot dispense it.

States require clinicians to be registered to certify patients for cannabis use.

Clinicians who certify are protected against federal legal repercussions.

Some states require clinicians to have ongoing relationship with patients as needing history and physicals on these patients.

Cannabis is supplied to patients through state licensed dispensaries.

These are for profit centers selling any prep or production compliance with state law.

However we do not know quality as this is not regulated by FDA.

Most states allow access to dried flowers or whole plant cannabis.

None of this is covered by insurance.

Endocannabinoid system

Cannabis interacts with endocannabinoid system.

The endocannabinoid system is a network of receptors that send signals.

The type 1 cannabinoid receptor CB1 is highly expressed in the central nervous system concentrated in prefrontal cortex,basal ganglia,hippocampus,amYgdala,hypothalamus and cerebellum.

Retro synaptic gammaaminobutyric acid signaling generates the neuropsychiatric effects of cannabis.

CB1 receptors are also found in smooth muscle,myocardium,adipocytes,preganglionic symathetic neurons integrated with autonomic and endocrine systems.

The type2 cannabinoid receptorCB2 is expressed in peripheral blood mononuclear cells,macrophages,

 B cells and natural killer cells.CB2 receptors are also present in myocardium,vascular endothelium and

smooth muscle.

Our body synthesises endocannabinoid molecules and they are,

1.N- Arachidonoylethanolamine (AEA or Anandamide)

2.  2-arachidonoylglycerol

Both of these are agonists at CB1 and CB2 receptors.

Phytocannabinoids

These are naturally occurring molecules with affinity for cannabinoid receptors.Over 100 photo cannabinoid pd have been isolated from cannabis.

Concentrations of these cannabinoids in cannabis depend on cannabis strain and horticultural techniques.

Eat to beat disease

I wanted to share an important information with you all.

We all eat bread.However it is found that sourdough bread has more benefits than others and is a good choice.

It has been determined by studies that Lactobacillus reuteri the bacteria used for culture has important 

health benefits in improving immunity,signalling gut brain axis to release oxytocin which is a bonding or socializing hormone.

It also helps weight loss,suppress tumor development,speed up wound healing.

Vow! Eat your choice of bread and reap the benefits.

Indigestion

All indigestion is not food related.It could be secondary to low acid or secondary to low digestive enzymes.

If bloating,gas,indigestion happens within 30 to 45 minutes of eating it is probably secondary to low acid and Betaine treatment would be a good idea.

If bloating,gas and indigestion happen after 45 minutes then it is a good idea to treat with digestive enzymes first.

Signs and symptoms of low gastric acidity are,

Bloating

Belching

Burning and flatulence right after eating.

Multiple food allergies.

Itching around rectum

Cracked fingernails.

Dilated blood vessels in cheeks and nose.

Chronic candida infections.

The optimal pH of stomach is 1.5 to 2.5

Antacids and acid blockers increase it to 3.5.

This increase of ph blocks action of pepsin,an enzyme used in digestion of protein.

The stomach acid activates pepsin and helps digestion of protein and encourages flow of bile and pancreatic enzymes.

Acid also helps in absorption of folate,B12,ascorbic acid,beta carotene,iron,zinc,magnesium.

How do we dose Betaine?

Start with one pill with each meal.

Increase by one more tablet each meal,i.e if one tablet does not cause any problems with first meal ,

Then next meal you can increase to 2 tablets and the following meal to 4 tablets till you reach 7 tablets

Or you feel a warmth in the chest.

Then reduce the Betaine dose by one tablet.

Cut down the number of pills once you regain the capacity to produce acid.

The digestive enzymes are best taken before meals

Please note,Probiotics do not digest food.

Cancer clock

What is cancer clock.

Simply put,it is mean time interval between two cancer cases.

It is 30 secs in USA,it is 4 minutes in Australia,

Doc,what can I take? I have the flu and can't take tamiflu

This is the flu season.

You should have had your flu shot by now.

I will outline some measures you can take to stay healthy.

1. Rest

2.Drink lot of fluids

3. I like Broncial wellness syrup ,echinacea or Blackelderberry syrups for cough.

4.Take extra Vitamin D,vitamin C

5.Viracid,a supplement is very good to aid in recovery and help immune system.

6.Wipe surfaces like counters,desks,phones.

7. Sleep atleast 8 hours.

8. Golden milk is very healing.read my previous blog for recipe.

9.Warm soups with garlic and onions help heal.

10. A vitamin C given IV in small doses or a Myers cocktail would be great addition to fast recovery.

11.Astragalus and turkey tail mushrooms are both good to improve immunity against viruses.

Hot chocolate

I have been craving for hot chocolate since the weather is on the cooler side right now in Texas and my nephews in New Delhi are singing glories of Ghiradeli hot chocolate sendingmephotos sipping on it in Delhi where it is even colder than Texas.

I would start with giving you different combinations of how I have used hot chocolate.

One can use nut milks like almond milks or cashew milk or any nut milk,specially if you are vegan.

If not milk plus 1 or 2 heaping tsf of hot chocolate.Be sure milk is hot.

To tthis combination add 1/2 tsf of cardamom and a pinch of cinnamon.

Another variation of this is add 1 tbsf of pumpkin purée mixed with tsf of maple syrup and add to hot chocolate and stir.

Sip and enjoy.

Dr.Dave's recipe of GOLDEN MILK

1 cup milk

3/4 tsf turmeric powder

1/4 tsf cinnamon powder

1/4 tsf cardamom powder

1 tsf Manuka honey or 1 tsf maple syrup

1/4 tsf cayenne pepper

1 tsf chopped ginger fresh or dried powder.

1/4 tsf black pepper ground

Almond milk can be used instead of regular milk.

I like to add 1/2 tsf of ghee or butter to the milk as my mom used to do .

It reminds me of Dave Aspreys  coffee with butter.

One can use 2%,or1% milk

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.