Cal Dept. of Health Epidemiologist on Better Use of Antibiotics

Buried in an article about overuse of the wrong antibiotics creating "super" drug resistant bacteria http://www.latimes.com/news/local/la-me-infection-20110329,0,2329300.story(there is a current outbreak of Klebsiella pneumoniae, or CRKP, affecting at least 356 patients in Southern California in the last year)is this excellent section, What can patients do. However, what is nonsense, in part, is the Dept. of Public Health epidemiologist blaming the victims for the over prescription of antibiotics. Over the past 18 years, I have seen hundreds and hundreds and hundreds of patients pushed by their doctors to take unnecessary antibiotics for viral disorders like bronchitis and ear infections.

Yeah, patients need to be educated not to push for antibiotics. But who should educate them? That is the job of the M.D.'s themselves! Stop pushing drugs, guys? What really needs to change is the M.D.'s themselves who all too often give patients antibiotics "just to safe," while neglecting to advise them on the most basic nursing skills, like getting rest and pushing hot fluids. They are not practicing science-based, evidence-based, medicine.

Moreover, with other disorders, like low back pain, they are all to quick to give drugs like Vicodin and Percocet, which do not even reduce the inflammation that causes the pain (whereas ibuprofen does) which is so idiotic, especially since Vicodin causes constipation, which in turn forces patients to bear down hard with bowel movements, which is itself one of the tests for a bulging disc (called the Valsalva maneuver.) So if you become constipated and you have a mild disc bulge, you could actually worsen it. At least tell your patients to take stool softeners if you give that stuff.

But why not send them for acupuncture? Duh Uh! I had a patient just this week who had been given steroids! Frikkin steroids, which have a host of dangerous side affects. She also had percocet. They were doing nothing. One deep tissue trigger point acupuncture session with me and she was 50% better. Come on, western medicine needs to open its eyes and smell the needles.

Here is the excerpt from the article. The whole thing can be had here: http://www.latimes.com/news/local/la-me-infection-20110329,0,2329300.story

"What can patients do?

It's not right to pressure your doctor to give you antibiotics for a viral infection. We need to be cognizant about limiting the use of antibiotics, period, because we really are going to have problems. CRKP and MRSA (Methicillin-resistant Staphylococcus aureus) are the end result of us using antibiotics perhaps not as well as we should be using them. We have now developed these organisms that know how to combat even our biggest and baddest antibiotics. We cannot have these multi-drug resistant organisms running rampant. It's a good reminder to everyone, patients and providers, that we need to be really prudent when we give antibiotics to everyone, in-patient and outpatient.

What should patients ask their doctors?

Unfortunately, the culture now in these doctors' offices is you go in and say, 'I have bronchitis' and demand antibiotics.

Let's say you have bronchitis and you take [azithromycin]. Most cases are viral. If you had bacteria in your respiratory tract, they may have developed resistance. If you develop bronchitis that is bacterial, the next time you're treated the [azithromycin] might not work.

The public needs to give doctors that option to say that it's a virus instead of demanding antibiotics. We can also help doctors understand that it's OK to tell a patient to go home and rest and you don't have to give them something to make them feel like they got something out of the appointment. That is the culture. What we're trying to do with this initiative is to swing it the other way."


Ayurveda, Acupuncture, and Chinese Medicine in San Diegohttp://www.bodymindwellnesscenter.com

Kitchen Medicine Cooking Medicine: Winter Papaya Salad with Toasted Black Sesame

Kitchen Medicine Cooking Medicine: Winter Papaya Salad with Toasted Black Sesame: "Winter Papaya Salad with Toasted Black Sesame Papaya is one of the few fruits (the other being banana) that are recommended with other fo..."

Ayurveda, Acupuncture, and Chinese Medicine in San Diegohttp://www.bodymindwellnesscenter.com

Winter Papaya Salad with Toasted Black Sesame

Winter Papaya Salad with Toasted Black Sesame

Papaya is one of the few fruits (the other being banana) that are recommended with other foods. Papaya is especially good with proteins, due to its high levels of the digestive enzymes papain and chymopapain, which act similarly to pepsin. It is also warming, and kindles the digestive fire (Agni), unlike many fruits, which are cooling, so it is good even in winter. (Please avoid cold fruits like melons in winter)

Here in the southwest we get lovely large Maridol papayas from Mexico, similar or identical to the ones you get on the east coast from the Carribean. In the supermarket you see the orange ones, but at the Vietnamese market I found more reddish ones, that are sweeter, more fragrant, and have a lovely color that contrasts so nicely with the black sesame in this dish.

I made this recently and brought it to Jerry and Anna's house for dinner. They served Oaxacan lamb cooked in banana leaf with chili sauce. This salad was a perfect accompaniment; the moist, light, Agni-stimulating nature of the salad helping to digest the dense, heavy lamb, which was slightly dry from his cooking method, and the cooling, moist lime and coconut compensating for the dry, hot nature of Jerry's hot chili sauce.

This recipe calls for lime juice. Lemon is really a poor substitute. Lime is a completely different flavor, and goes with fruit in a way lemon does not. Lime is used with fruit and with chili throughout Mexico and South/Southeast Asia; it is considered cooling, and gives a delightfully fresh scent to fruit salad.


Ingredients

2-3 cups papaya, cut into chunks.
1-2 tablespoons fresh lime juice (i also really like the bottled lime juice from Iran, they are a different variety than the United State limes, with a wonderful fragrance like the limes in South India and Sri Lanka)
1-2 tsp raw sugar...i like raw coconut sugar...Indian jaggary or evaporated cane juice are also good. Its also great with honey instead.
1-2 tbsp toasted black sesame/coconut mixture (see below)
a pinch of salt if you want

Mix everything together a couple of hours before serving. Let it sit at room temperature so that all the flavors combine well.

Toasted black sesame coconut mix

Heat a heavy pan or wok to medium hot. Add black sesame. As it starts popping, add an equal amount of dried coconut. The best is from Sri Lanka. Keep stirring so nothing burns, lowering the heat if need be, or just removing from fire. You want the coconut slightly brown, not burnt. I then put this in the coffee grinder for a count of three--i want it coarse, not powdered. You could just grind it a bit in a mortar or suribachi, too. This is excellent in fruit salads.

Papaya in Ayurveda
Papaya is recommended in Ayurveda for balancing Vatta (moist, warming and sweet). As it is also a little astringent, and warm, it can be fine for Kapha, in smaller amounts. But if i were making the above recipe for Kapha, i would leave out the added sweetener.

On the other hand, Papaya increases heat in the body (virja), so it should be avoided most of time for Pittas, but again, there is a difference between a balanced Pitta and an unbalanced one; also between someone very Pitta dominant, and a Pitta Vatta. This is why diet must really be tailored to your unique constitution and your current prakruti.

So usage could like this.

Very Vatta Dominant or unbalanced: Eat frequently.
Vatta Pitta: Eat frequently, unless Pitta is unbalanced.
Pitta Vatta: Eat on occasion, esp if flatulant.
Kapha Vatta: Eat regularly, but not too ripe.

There are also the ways you balance the hot nature of this fruit, like mixing with rose water, untoasted coconut, or lime.

Because of the heat issue, Papaya is not recommended during pregnancy, and in Tamil Nadu I used to hear women avoiding it who were trying to get pregnant.


Papaya kindles ‘agni’/digestive fire, which in a sense makes it excellent for both Kapha and Vata, who tend to weaker fire by virtue of being dominated by cold water and air.

Obviously it is to be used with caution in a Pitta with heartburn, though even there, it might help, as some heartburners have lots of digestive stagnation aggravating their fire. So again, we must look at the specific case, rather than just forbid it to any Pitta.

I find it less aggravating to Pitta than very sour fruits like Kiwi, sour citrus, or Mango. But in all cases it is excellent for Ama (Digestive Toxin) accumulation, with thick or greasy tongue coating.

A person with excess Vatta will benefit from regular use of Papaya, especially if there is flatulence. It is also prescribed for dyspepsia associated with heart disease.

Papaya in Chinese medicine

Papaya is prescribed for digestive diseases in Chinese medicine, too. The unripe green papaya especially is used for digestive complaints. I have found Vietnamese green papaya salad an amazing digestive. The ripe fruit is used more for dysentery, urinary complaints and constipation. I recommend it all the time for constipation in my practice, and have had excellent results. Unfortunately a lot of United Statesans seem to dislike the flavor of papaya. If they try my salad, I think they will change their minds! :-)

copyright eyton j. shalom, march 2011, san diego, california. use with permission, all rights reserved.








Ayurveda, Acupuncture, and Chinese Medicine in San Diegohttp://www.bodymindwellnesscenter.com

My Grandmother's Spice Cake, Banana Cake, and Potato Latkes

Chinese Medicine observes that not only do different foods have difference "natures" (cold, cool, neutral, warm, hot), for example the heat of cinnamon or lamb vs. the coolness of coconut water or cucumber, but so do each of the cooking methods.

The least "heating" method of cooking is simple steaming or boiling. Stir frying adds even more heat, due to, in my opinion both the actual high heat as well as the oil/fat used. Broiling and baking are considered even more warming, and deep frying the most warming.

I think anyone who has ever eaten a french fried potato or grilled salmon can attest to the warm feeling you get vs eating a boiled potato or steamed salmon.

Now, about my grandmother's wonderful spice cake. In the world of sweet things, baked cakes are on the warming side, like muffins and pancakes, especially suitable to winter. Whereas ice cream, which I have no credible "health" defense for, other than the slogan "nothing is so healthy as a modest amount of intemperance", is obviously quite cooling, so suitable in tiny amounts to the summer months.

I recently discovered some faded scraps of paper from 1983, when my mother quickly wrote down for me the recipes for my grandmother's two famous cakes, one Spice, the other Banana, and also for her Potato Latkes, a kind of pancake eaten in winter, especially for the holiday called Chanukah.

I remember as a small child feeling so deprived by this spice cake. My idea of cake was chocolate with lots of layers and icing. But by the time I hit my 20's, I yearned for this cake. In 1977, during my first sojurn in India, my mother actually sent me, wrapped in foil, half a spice cake. Madras is not a place where you found bread or cake at all in those days. Only Indian sweets. So what a boon it was when the postman showed up at our gate, calling out, "post! post!", to see in his hands a package from my mother, thousands of miles away, and inside, food stuffs for my emaciated body, down to 150 lbs (I am 6'0") from the effects of the dysentery that all of us foreigners used to get back then.

The mother of our ashram, Laksmi, who had never had cake in her life, broke into a big smile when I showed her the contents, as a mother of four herself, she very much appreciated this loving gesture. And when I gave her some for her family, and she tasted it, her eyes lit up and she nodded her head sideways in the typical south Indian gesture of approval.

In any case, as a celebratory farewell to winter 2011, (in San Diego it was 67 with a dry wind today, and at night the mockingbirds sing their hearts out announcing, if anyone had any doubt, that spring is, indeed, here)here are my grandmother's recipes, as written by my mother, of blessed memory, from some time before the 1940's, if not earlier.

I am sure these could be modified with whole wheat pastry flour and reduced amounts of sugar. Perhaps they could be done with agave syrup or coconut palm sugar, both having lower glycemic indexes. The very ripe bananas make the first cake naturally sweet, to. I might try adding some cardamom and even saffron to the banana cake.

Ayurveda

Both cakes being warming, unctuous, heavy, and sweet, are very suitable to Vata types, especially if they are of the thin, cold, and dry type. A balanced Kapha could have a small piece. Ditto Pitta, although the spice cake might not work for an unbalanced Pitta with heartburn issues, though i doubt a small piece with some oolong tea would cause much problem.

Shoshana Rudavsky's Banana Cake, from my mother's hand.

Cream 1/2 cup shortening with 1 & 1/3 cup sugar until light.
Add 2 eggs and beat. (I dont understand this, shouldnt this happen separately?)
Dissolve 1 tsp baking soda in 1 cup sour milk or yogurt and add.
Mash 2 very ripe bananas (peel is brown) and add to batter.
Combine 1 tsp baking powder with 2 cups cake flour.
Combine all the ingredients and mix a bit.
Pour into a greased baking pan.
(They used to use the round ones with the hole in the center)
Bake in moderate oven (350 degrees) for about 40 minutes.

Options:

My mother often added walnuts, and near the later part of her life, chocolate chips.
Once she made it with applesauce, rather than bananas, and reported using 1 baby applesauce jar's worth, which seems like too little to me...
Mother's notes carry the following addendum:

" Can just throw in all the ingredients in order written as I do--Stir and bake, a quick job (does not make as big a cake as the other)"
Now I am not a baker, but I don't know how the eggs get adequately dissolved in this scenario...


Ida Levy's Spice Cake, from my mother's hand.

Ingredients:

2 cups cold water
2 cups sugar, white or brown
2 cups raisens
1 cup cooking oil
2 tsp nutmeg
2 tsp cloves
2 tsp cinnamon
2 tsp baking soda

Combine the above in a pot and bring to a simmering boil, stirring the whole while. Don't allow it to stick. Set aside to cool (she adds "sometimes I don't have time to cool very much").
After cooling add
4 cups flour
1 cup slightly crushed walnuts
1 tsp baking powder
and stir well.

Pour into greased pan and bake in hot oven about 90 minutes (she comments, "It never seems to take that long...test with a toothpick")
"Makes a nice big cake."

note: i am sure i saw my mother adding ginger to this when i was a teenager, but i could be mistaken. definitely the leading fragrance is of nutmeg and clove....having made spice cake pancakes with ginger added, i can say its not a bad addition in any event.

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Sara Rudavsky Soltes' Potato Latkes

2 eggs
3 cups grated, drained potatoes
4 tbsp grated onion
1 tsp salt
1/4 tsp pepper
2 tbsp matzo meal or cracker meal (she adds "i dont think i usually add this")
1/2 cup oil or butter

Beat eggs, add all the ingredients except the butter/oil.
Heat 1/2 the butter in a frying pan.
Drop the potato mixture into the hot oil/butter by the tbsp.
Fry until brown on both sides.
Keep pancakes hot until all are done, adding more oil to pan as needed.










Ayurveda, Acupuncture, and Chinese Medicine in San Diegohttp://www.bodymindwellnesscenter.com