Recently in Ma Personal Health Blog Category

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   It's September, and the garden is bursting with zucchini, summer squash, peppers, eggplants, carrots, oregano, rosemary, thyme and basil, all crying out to be made into delicious Italian food. What's a poor gourmet to do?  Well, what I really enjoy is the amazing 'Spaghetti Indiano' sauce we create at the ashram, http://www.alandiashram.org/gurukula_blog/2011/10/spaghetti-indiano.html or the delicious pesto made from our basil. So instead of subjecting myself to a pasta carb load, I've been making raw zucchini fettuccine. First peel the zucchini. Discard the peel and then keep going with the peeler, creating fettucine-like strips. Put the strips in a bowl and sprinkle liberally with salt. Toss to mix in the salt, cover and leave for at least an hour. Rinse thoroughly in a colander to wash off the salt, pat dry with paper towels, toss in olive oil and there's your pasta. You could warm it gently but I usually have it a room temperature with hot spaghetti sauce. This is also a great way to use overgrown zucchini.
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Hallo dear readers and sorry for my long absence from the internet! In the next few entries I'll be taking the opportunity to catch up on all the ideas and developments I wasn't able to share with you over the summer. So today I want to let you know about the impact of receiving excellent, stellar healthcare during my trip to the UK.

As many of you know, I recently traveled to London to receive a diagnostic hemithyroidectomy (medical lingo for removal of half the thyroid to see if the nodule was benign or malignant). My internet searches of thyroid surgeons 
had led me to Mr Fausto Palazzo, the UK's top thyroid surgeon, and I counted myself extremely fortunate that he was willing to see me. ( It may seem confusing, but surgeons in the UK are traditionally called Mr, rather than doctor.) I soon found that my experience of receiving such outstanding care had repercussions for me not only as a patient but also as a doctor. By experiencing what it was like to be a patient at a crucial and vulnerable moment, I received fresh insights on what is important in clinical practice.

I observed that there were four features that combined to create an excellent clinical encounter. The first, of course is expertise, the reason I chose Mr Palazzo in the first place. Excellence is not possible without expertise and expertise requires a continual engagement in study and practice. If athletes train and work so hard for the Olympics and Paralympics, how much more so do those of us involved in healthcare need to hone our skills continually. We hold in our hands people's lives and well-being. 

However, there are three other aspects that combined to create a full experience of excellence. All of us have probably at one time or another had the misfortune to see a doctor expert in his field who was still incapable of delivering patient satisfaction because of the lack of these other features. The first of these features is teamwork. I saw that Mr Palazzo had a trusted team of people around him, all of whom contributed in various ways to patient satisfaction. The sense of being held by a team created safety and relaxation essential for healing to occur.

The second, absolutely vital aspect was the warmth and empathy I received from Mr Palazzo himself as well as from the anaesthetist, staff nurses and hospital orderlies. Often I have heard from my own patients about negative experiences they had with highly trained and respected doctors. The number one complaint my patients have  expressed regarding these specialists is lack of warmth and empathy and a dismissive, arrogant or judgmental attitude. Expertise is clearly not a stand-alone criterion for excellence.

Finally, there was a tremendous sense of joy, enthusiasm and positive energy that radiated from Mr Palazzo and everyone around him. It was extremely helpful to feel such an atmosphere of joy and positivity while going into surgery.

 By having the opportunity to observe myself in the midst of this experience, I saw that the non-quantifiable factors--teamwork, empathy and enthusiasm, were much more than warm and fuzzy feel-good optional extras.  Rather, I realized that these aspects of the clinical encounter caused my heart and brain to release oxytocin. And oxytocin lowers cortisol, reduces stress, improves immunity and supports faster wound healing--all essentials for a good recovery from surgery. No wonder my wound was healing  so  nicely!

The experience as a patient has impacted my own practice by showing me that the things I think are important in healthcare truly are important. In striving every day to learn more and become more expert, in building a strong team with staff and students, in devoting my life to loving-kindness and compassion and in finding immense joy in my work, I'm supporting my my patients' health in ways that have only now become clear to me.  

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bhakri served as a part of indian meal

bhakri served as a part of indian meal (Photo credit: Wikipedia)

Diet has certainly been a perplexing topic for me over the years. After all, I give Ayurvedic nutritional advice to others and they lose weight. Why not me?

One of the big debates I see in diet is the dichotomy of the calories in/calories out view versus the diet composition view. What's important--how much you eat or what you eat?
 
According to sources such as Web MD, losing weight should be pretty simple as it's just a matter of eating fewer calories than you burn. I decided to test this for myself, so for a month I used an online calorie counter. At the outset, let me
say that I do recommend this to anyone dealing with overweight or obesity, as an exercise. Many of my obese patients do in fact consume far more calories than they burn. Bags of corn chips, one pound bags of M&M's, quarts of ice cream, visits to McDonald's or Burger King, sodas etc do often form part of the diet of someone first presenting for Ayurvedic care. Although I don't eat such things myself, still I  I found it quite helpful to review my diet, look for any excess calories and make simple changes.

But what I learned for myself was that I do in fact, on a daily basis, consume significantly fewer calories than I burn. And despite cutting calories even more, I didn't lose an ounce.  This was a fascinating exercise in disproving, for myself, the calorie myth. Of course, now I could wade into other diet controversies--low fat vs low carb. etc. But, I had Ayurveda to guide me. According to Ayurveda, there is no one diet that is right for everyone. It's mandating 'one size fits al
l' that makes any diet a fad. A person's diet is determined by their constitution, current imbalance and the condtion they are dealing with. As a pitta, I've naturally gravitated to a pitta-soothing diet, focusing on the sweet, bitter and astringent tastes. I' m not into desserts or sweet baked goods, but the sweet taste includes grains such as rice and wheat, as well as fruits. Vegetables such as greens and bitter gourd provide the bitter taste, while salads and legumes are astringent. So there it was, salads, rice, dal and veggies--my perfect meal! Of course, in recent years I've cut back the quantity of rice, but still its been a staple.

Understanding that I have insulin resistance and undiagnosed PCOS has helped me appreciate that kapha is at the root of my current concerns. (It's hard, by the way, to be your own doctor. I 'm up too close to see myself in perspective). The composition of a kapha diet focuses on bitter, pungent and astringent. Now, my inherent pitta rules out much pungent, so that leaves bitter and astringent. That's most of what I already eat--except for the grains! It was a short leap from there to deciding that, with insulin resistance, I simply need to leave off the dense starches--the grains, endowed with the sweet taste.

Of these grains, wheat is the densest, heaviest and most kapha provoking, so I decided to go off wheat and gluten grains altogether and leave rice as a occasional treat (or something to eat when I'm not in charge of my own menu). Instead I'm using the lighter, astringent grain substitutes like quinoa and buckwheat.

I was happy to see that with a strict kapha-pacifying diet, the scale is actually starting to move. It was a relief to see that something can actually work and I'm not condemned to obesity as  life sentence. I recommend a grain-free diet to anyone with insulin resistance. And I'm thrilled to see that Ayurveda is yet again proved right!
English: cooked red quinoa

English: cooked red quinoa (Photo credit: Wikipedia)








 
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Setubandhasana - Bridge Pose सेतुबंधासन

Setubandhasana - Bridge Pose सेतुबंधासन (Photo credit: Wikipedia)

One of the asanas that figures in my regular practice is setubandhasana or bridge pose. For example, this morning I did nine repetitions of bridge pose as part of a female energy rejuvenation series that I do regularly. Of course, I started wondering why I like setubandhasana so much and what other benefits it has, aside from toning and rejuvenating the female reproductive system.

 It turns out that setubandhasana is ideal for obesity, overweight and metabolic syndrome. First of all, it is one of the very best asanas to rejuvenate and stimulate the thyroid, thus improving metabolism. Secondly, setubandhasana helps lower the blood pressure. As an important anti-hypertension asana, setubandhasana addresses one of the key components of metabolic syndrome.  Thirdly, setubandhasana is great for reducing stress. And as I have discussed in several blog posts, stress is an important co-factor in the development of insulin resistance and metabolic syndrome. As an added benefit, setubandhasana is helpful in preventing osteoporosis, a condition that often affects women at about the same age that insulin resistance and hypothyroid make themselves known.

Setubandhasana is a pose suited to all ability levels--as long as you can get down on the floor.  As always, don't try yoga at home without first seeing a yoga teacher to be sure the pose is right for you and you're doing it correctly.

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Yoga and metabolic syndrome

 

People in various yoga asanas. Original title ...

People in various yoga asanas. Original title and description: "AsanAthon 2" Participants in Diamond Mountain's first AsanAthon. (Photo credit: Wikipedia)

Like many of you who are reading this blog, I enjoy practicing yoga or chi gong as a part of my daily exercise programme. These contemplative movement arts are meditative and centering, so I appreciate doing them. Imagine my consternation when Dr Weber explained that yoga and chi gong are not aerobic and so won't meet my exercise needs, even though they are good to do. Or to put it another way apparently I still need an hour of exercise a day aside from yoga or chi gong. Her's a quote from the study I imagine Dr Weber was referring to "Sixty minutes or more of continuous or intermittent aerobic activity, preferably done every day will promote weight loss and weight maintenance. The latter include multiple short (10-15 minute) bouts of activity (walking breaks at work, gardening or household work), jogging, swimming, biking, golfing, or team sports. An equal balance between aerobic exercise and strength training is advised."

It's taken me a while to digest and process this. And here are a few things I've realized along the way.

 

First of all, yoga and chi gong provide deep relaxation and release of tension even in the midst of exercising. It's not only shivasana (corpse pose) that offer a deepening into the parasympathetic state, but also many asanas, as we discussed a few days ago when talking about rabbit pose. And not just asanas, but pranayama also offers significant stress reduction benefits. Stress is a key element in metabolic syndrome, particularly where hypertension and belly fat are concerned.

 

Another point that has become clear to me recently is that musculoskeletal degenerative conditions are associated not just with age and wear and tear but also with impaired microvascular blood flow (I wrote about this in my last blog, on shoulder injuries). And impaired flow in small blood vessels is related to diabetes, pre-diabetes and insulin resistance. In other words, those of us with insulin resistance are at increased risk of musculoskeletal degenerative disorders. Degeneration of joints such as the knees can make it difficult to walk upstairs, what to speak of doing aerobic exercise. So here comes a vicious cycle--lack of exercise/metabolic syndrome/knee degeneration/lack of exercise/worse metabolic syndrome. And this is compounded by obesity giving the knees more to carry and lack of exercise increasing obesity. Yoga offers an excellent path to move and energize all the joints, providing increased blood flow and maintaining flexibility. And today, with yin yoga, restorative yoga, chair yoga, bed yoga--all mobility levels can do some asanas and pranayama.

 

After mentally designing a study to prove that I really do need to do yoga and chi gong, I found that a lot of researchers have beaten me to it! A 2008 pilot trial at the University of California determined that, "Restorative yoga was a feasible and acceptable intervention in overweight adults with metabolic syndrome. The efficacy of yoga for improving metabolic parameters in this population should be explored in a larger randomized controlled trial." (2) In 2005 a literature review article published in the Journal of the American Board of Family Medicine noted that "collectively, these studies suggest that yoga may reduce many IRS-related risk factors for CVD, may improve clinical outcomes, and may aid in the management of CVD and other IRS-related conditions." (Note: IRS = insulin resistance syndrome) (3).A 2008 study from India notes that "Participation of subjects with T2DM (Type 2 diabetes) in yoga practice for 40 days resulted in reduced BMI, improved well-being, and reduced anxiety." (4). And the study cited above in reference to aerobic exercise goes on to say, in the next paragraph, "Thus, it is clear that a comprehensive approach consisting of weight reduction, regular physical exercise and yoga is crucial in control of the insulin resistance state that characterizes the metabolic syndrome."

I'm sure that was what Dr. Weber, who is a holistic physician, meant to convey. Sometimes we hear what we hear, and go through our own process. And the studies I've cited are only referring to the benefits of yoga on markers of metabolic syndrome and not even to the added musculoskeletal piece I mentioned.

So, walk more but don't substitute walking for yoga!

 

1. PC Deedwania, R Gupta, Management Issues in the Metabolic Syndrome JAPI 2006

2..Beth E. Cohen, A. Ann Chang, Deborah Grady, and Alka M. Kanaya. Metabolic Syndrome and Related Disorders. September 2008, 6(3): 223-229. doi:10.1089/met.2008.0016.

3. Kim E. Innes, Cheryl Bourguignon, and Ann Gill Taylor, Risk Indices Associated with the Insulin Resistance Syndrome, Cardiovascular Disease, and Possible Protection with Yoga: A Systematic Review J Am Board Fam Pract November-December 2005 18:491-519; doi:10.3122/jabfm.18.6.491

4. Madhu Kosuri Ph.D.Gumpeny R. Sridhar M.D., D.D., F.A.C.E.. Metabolic Syndrome and Related Disorders. December 2009, 7(6): 515-518. doi:10.1089/met.2009.0011.

 

 

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Dealing with setbacks

Robert the Bruce kills Sir Henry de Bohun on t...

Robert the Bruce kills Sir Henry de Bohun on the first day of the Battle of Bannockburn. (Photo credit: Wikipedia)

 

My sprained ankle has naturally led me to reflect upon setbacks in our pursuit of health and fitness. The moment I decided to increase my exercise (which, incidentally, already exceeds the generally suggested guidelines), I immediately sprained my ankle.  And I can think of so many similar incidents. I get really fit and vigorous, doing a lot of sprinting, and then break my arm.  I get fit again, start running, and there's a heat wave and I can barely move. I pick up from the heat wave and get h1n1 and have to build back up again. Once I get over the sprained ankle I'll have to deal with getting fit again after surgery.

I'm sure each reader can tell a similar story. Fortunately, I won't be competing in the Olympics, so fitness setbacks are not catastrophic. Setbacks invite a philosophical view. According to madhyamika Buddhist philosophy, we need to have a union of the relative and absolute view. From the relative perspective, I'm responsible for this body and the precious opportunities embodied life offers me to practice the dharma and benefit beings. So following guidelines of self-care is inherent in the dharma.  But from the absolute point of view, this body is impermanent, inevitably painful and void of any real essence. It arose and it will pass away. Whether I' m a junk food eating couch potato or an Olympic athlete, the only thing certain in life is death.  Life's setbacks and ups and downs are determined by karma, not by my wishes or efforts.

There are two curves in effect in my life and they move in opposite directions. One is the curve of constant efforts to enhance wellness through Ayurvedic self-care, leading to increasing general wellbeing. The other curve is the ageing process leading to degeneration decay and death. And as part of the ageing process, various genetic time bombs go off despite our efforts to defuse them.  It's a matter of having

"the serenity to accept the things I cannot change;
courage to change the things I can;
and wisdom to know the difference."

To put it another way, choiceless awareness, no preferences. Staying present with what is helps us not to get discouraged by setbacks.

My father used to tell a story of Robert the Bruce of Scotland and the spider. After six defeats by the English army, Robert retreated to a cave, utterly discouraged. As he lay in the cave he watched a spider spin her web. Time and again she tried to throw her thread across the cave, only to fail. Yet she just kept trying until at last she was able to bridge the cave with her thread. The spider inspired Robert Bruces' eventual defeat of England at the Battle of Bannockburn. May she inspire us to face our setbacks and continue the path of wellness!

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Age and metabolic syndrome can affect us in unexpected ways. Up to 39% of people over sixty have full-thickness rotator cuff tears (1) in one or both shoulders, which often come on gradually with no history of shoulder injury. Such rotator cuff tears in elders are thought to be a degenerative age-related condition due in part to impaired blood supply (2,3). And the cause of impaired blood supply leads us back to metabolic syndrome and diabetes, where elevated blood sugar levels cause damage to small blood vessels.

Last year Sadananda had  very painful rotator cuff tear, triggered by the repetitive motion of spooning ghee into the fire during a month-long Vedic fire retreat. It was treated by PRP injection--platelet rich plasma, a very painful and debilitating but quite successful treatment. While I've not had shoulder pain myself, I do notice that my shoulders pop excessively, which could be pointing to some degree of rotator cuff degeneration.
We exercise our shoulders with a simple chi gong practice. First we extend the arms out horizontally, pushing out stale chi and pulling in fresh chi. Then we push forward, pushing out stale chi, and pull back, drawing in fresh chi. With this exercise, I hope to protect my shoulders.

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1.Bigliani LU, Morrison DS, April EW. The morphology of the acromion and its relationship to rotator cuff tears. Orthop Trans. 1986;10:228.

2. Yamanaka K, Fukda H. Aging process of the supraspinatus tendon in surgical disorders of the shoulder. In: Watson N, ed. Surgical Disorders of the Shoulder. New York, NY: Churchill Livingstone; 1991:247.

3.  Uhthoff HK. The microvascular pattern of the supraspinatus tendon. Clin Orthop Relat Res. May 1990;254:35-8.


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Rabbit-Pose.jpgMetabolic syndrome is intimately associated with stress. Chronic stress raises cortisol levels, leading to central obesity. Chronic stress raises blood pressure. And hypertensive individuals suffering from chronic stress have an increased likelihood of developing heart disease (1). So it stands to reason that those of us with metabolic syndrome and insulin resistance need to have some good stress-reduction strategies.

I really enjoy doing Rabbit Pose (sasangasana) for stress reduction. For many years now, I haven't been able to do headstand due to neck problems. Rabbit is my headstand substitute, providing many of the benefits of inversion.  Rabbit pose relieves stress on the spine. But most of all, Rabbit Pose provides a womb-like experience of deep grounding and relaxation. I feel a mellow, parasympathetic state induced, which naturally helps lower blood pressure. The crown of my head is sensitive, so I use a lot of padding for my head, so I can enjoy hanging out in the pose. And because of blood pressure medication I'm prone to dizziness, so I have to be careful to come out of the pose gently and slowly. We usually do four repetitions of Rabbit Pose during our daily stretch routine. And our necks and backs are warmed up before we get to Rabbit.

Of course, if your blood pressure is really high, ask your doctor before doing any inversions. People who are new to yoga should see a yoga teacher before trying anything at home. That aside, enjoy rabbit pose!

 

1. A Path Model of Chronic Stress, the Metabolic Syndrome, and Coronary Heart Disease PETER P. VITALIANO, PHD, JAMES M. SCANLAN, PHD, JIANPING ZHANG, MS, MARGARET V. SAVAGE, PHD, IRL B. HIRSCH, MD, AND ILENE C. SIEGLER, PHD, MPH

 

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phyllanthus niruri

phyllanthus niruri (Photo credit: Wikipedia)

The great thing about a personal health blog is that, for the first time in my career as an author, I'm writing from a patient's point of view, sharing my personal journey with fellow-sufferers in the most educational way I can. And when it comes to insulin resistance and metabolic syndrome, there are all too many fellow sufferers--a quarter of the US population, and about the same figure for Europe and Latin America.

 

So today I'd like to share my experience with a herb that is a natural gift for people with metabolic syndrome. Since my recent telephone appointment with Dr Vasant Lad, I've been taking bhumyamlaki daily. Also known as Chanca Piedra, bhumyamlaki is an important herb in both the Ayurvedic and Western pharmacopoeia, growing both in India and in the Brazilian rainforest. Its Latin name is phyllanthus niruri.

 

Bumyamlaki is famous for its hepato-protective actions, meaning that it helps keep the liver safe from internal and external enemies. People with hepatitis B or C should use this herb to protect the liver. It is also antiviral for hepatitis and HIV. But those of us with obesity or metabolic syndrome face danger to the liver too, in the form of our increased incidence of non-alcoholic fatty liver disease. So we too can use this herbal superhero to defend our liver cells.

 

And that's by no means all bhumyamlaki does for metabolic syndrome. In fact, bhumyamlaki is well established to lower blood sugar, lower cholesterol and lower blood pressure (1). Remember those markers of metabolic syndrome we discussed in a previous blog? Raised blood sugar (above 100mg/dl), hypertension, high triglycerides and low HDL (good cholesterol) were among the markers, along with abdominal obesity. So how amazing is it that one herb can help you out so much, stepping into the place of metformin plus statins plus ACE inhibitors? No wonder I called bhumyamlaki a superhero!

 

Many of my patients take bhumyamlaki at bedtime and claim it helps their sleep. I've been taking mine in the morning an hour after my thyroid medicine and actually along with blood pressure medication (hydrochlorthiazide). In due course I hope to take only the bhumyamlaki and not the blood pressure medication, but herbs do act more slowly than drugs. Bhumyamlaki is an energizer and I'm finding it helps me feel energized in the morning. In either case, you can take a teaspoon of bhumyamlaki, steep for ten minutes or more (I do an hour) in boiling water, strain and drink. The first sip tastes bitter and then it's OK, I just gulp it down knowing I'll feel good afterwards!

 

As I'm getting clearer about why I'm writing this blog, I can see that it could be extremely helpful to a lot of people. So spread the word, subscribe to the blog, share on Facebook, tell your friends with PCOS, metabolic syndrome or thyroid problems etc. about the blog, so we can help as many people as possible.

 

1. G. Bagalkotkar, S. R. Sagineedu,  M. S. Saad,  J. StanslasPhytochemicals from Phyllanthus niruri Linn. and their pharmacological properties: a review. Journal of Pharmacy and Pharmacology Volume 58, Issue 12, pages 1559-1570, December 2006

 

 

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English: bitter gourd Deutsch: Bittermelone

English: bitter gourd Deutsch: Bittermelone (Photo credit: Wikipedia)

In creating a personal health blog, I'm thinking, of course, as in everything I do, about benefit for others. So I'll be sharing what works for me, what doesn't work, tips, strategies, ideas. Today I'd like to share regarding a very important vegetable, known variously as bitter gourd, bitter melon and Karela. Bitter gourd deserves its name. For some, it's an acquired taste--but worth the effort.

 

First of all, for all of us with metabolic syndrome, PCOS and other manifestations of insulin resistance, bitter gourd increases insulin sensitivity and reduces weight. There are over 100 studies to this effect, I've just cited one (1). In addition, bitter gourd is antibacterial and antiviral. It's antiviral effects work against HIV and Hepatitis C (2). Bitter gourd is also anti cancer with efficacy on breast and prostate cancer, skin cancer, melanoma, leukemia and other common malignancies.

 

There are two varieties of bitter gourd. A darker green karela, looking like a warty cucumber, can be bought at Indian markets and a smoother, ligher green one at Oriental markets. The oriental variety is less bitter and cooks faster but the Indian one is probably more medicinal precisely because more bitter. Here's a picture of the Oriental  variety and the other photo, above, shows the Indian variety,

English: Bitter melon Tiếng Việt: Khổ qua, mướ...

English: Bitter melon Tiếng Việt: Khổ qua, mướp đắng (Momordica charantia) (Photo credit: Wikipedia)

 

Back when we were wandering sadhus in India, Sadananda and I would sit down by the roadside, set up our three stone and three stick cooking 'stove' and simply steam our bitter gourds on top of rice. We thought of ghee and spices as decadent luxuries and felt fortunate even to have salt! Today we still eat bitter gourds every week, but our recipes are more sophisticated now we have decided spices are an Ayurvedic necessity rather than a luxury. You can stir fry or steam bitter gourds and spice with turmeric, cumin and hing (asafetida). Or here's a recipe I created using another vegetable that lowers blood sugar--eggplant.

 

White Eggplant sabji  (Purple Eggplant works, too)

 

Eggplants are valuable in reducing cholesterol. White eggplant is said in Ayurveda to be very beneficial in diabetes. Here is  a recipe combining two vegetables revered in Ayurveda for their antidiabetic properties. White eggplant is seasonally available  and bitter gourds are available at India's Grocery.

1lb white eggplants

1lb bitter gourds

1 medium tomato, chopped

1 bunch cilantro, chopped

1 inch piece fresh ginger, finely chopped

2tsp turmeric

1tsp mustard seeds

1tsp cumin seeds

½ tsp fenugreek seeds

1tsp garam masala

1tsp salt

1Tbsp ghee or sunflower oil

 

Cube the eggplants and marinade for at least an hour in the tumeric. Meanwhile, slice the bitter gourds and remove the seeds. In a wok, heat the oil or ghee and then fry the mustard seeds ,cumin seeds and fenugreek until the mustard seeds turn grey and pop.Add the ginger. As soon as the ginger begins to pop, add the tomato. Cook for a few minutes, then add the bitter gourds. Stir-fry the bitter gourds for about 20 minutes, than add the eggplants and garam masala. Continue cooking until the vegetables are soft. Remove from the flame and add the salt and cilantro. Enjoy!

(1)M. G. Sridhar*, R. Vinayagamoorthi, V. Arul Suyambunathan, Z. Bobby and N. SelvarajBitter gourd (Momordica charantia) improves insulin sensitivity by increasing skeletal muscle insulin-stimulated IRS-1 tyrosine phosphorylation in high-fat-fed rats British Journal of Nutrition (2008), 99, 806-812 doi: 10.1017/S000711450783176X q The Authors 2007

2. J.K Grover  S.P YadavPharmacological actions and potential uses of Momordica charantia: a review Journal of EthnopharmacologyVolume 93, Issue 1, July 2004, Pages 123-132

 

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