Primal Blueprint 101. FAQs, Intro, PB 101 – whatever you want to call it this is a great place to familiarize yourself with the content found on Mark’s Daily Apple. The Wonderful World of Coconut Products. Coconut seems to have a special place in Primal hearts. Judging from the forums, people are pretty taken with the fatty pseudo- nut and they’re always interested in new ways to consume the stuff. For some who abstain from dairy completely, coconut products make a great replacement for creams and butters. Others see the evidence from South Pacific traditional groups who thrived on a diet of coconut and fish, and want a bit of that in their lives. The milk makes a great base for smoothies, soups, and curries; the oil is a great source of saturated fat that stands up well to heat; the water beats commercial sports drinks with its impressive electrolyte content; the nut itself can be used as a projectile weapon. It’s just a well- rounded, versatile food with some interesting characteristics and a ton of offshoot products. Unlike most food “products,” however, coconut products are legit. They’re real food, and they’re real good. To help you guys wade through the often- confusing world of coconut products, I’ve put together a little guide to them all. Of course, I’ve probably missed a few things, so share your thoughts with me in the comments section. Without further ado: We’ve mentioned coconut oil plenty of times before. Tons of our readers eat it. It’s good by the spoonful, with eggs, on your scalp, or as a moisturizer. It can even double as a benign form of suntan lotion. Coconut oil is primarily saturated (over 9. Use it for stir- frying and saut. Makes a good base for an energy bar. A tablespoon gets you 1. Tango is a soft drink primarily sold in the United Kingdom, Ireland, Sweden, Norway, Hungary and Malta, first launched by Corona in 1950 the name Tango came from Ivan. 5 Facts You MUST Understand if You Are Ever Going to Lose Your Belly Fat and Get Six Pack Abs 1. Many so-called "health foods" are actually cleverly disguised junk. Coconut butter is to coconut oil as butter is to ghee; it’s made from whole coconut flesh, with all the delicious fat and the solids included. The oil and flesh meld together to form a creamy texture that spreads well. I wouldn’t use it for any high heat cooking, though, as the bits of flesh will just burn. Spoonfuls of this stuff are delicious, but addictive. Because the flesh is included, it retains a decent amount of sweetness. A big dollop of coconut butter can really finish off a curry nicely, though. Two tablespoons get you 1. Coconut Oil. We’ve mentioned coconut oil plenty of times before. Tons of our readers eat it. It’s good by the spoonful, with eggs, on your scalp, or as a moisturizer. The book "Synoptic Materia Medica I" points out that Lycopodium may cause lack of self-confidence, feelings of inferiority and. Coconut milk is made by mixing shredded, fresh coconut meat with water, then squeezing it through a sieve or cheesecloth. The thick, creamy liquid that comes out is coconut milk and can be used for Thai curries and Brazilian seafood stew. Personally, I love drinking a big chilled glass of it by itself. Because people tend to misinterpret the natural separation of coconut milk in the can as spoilage, most canned coconut milk often includes thickening agents like guar gum, especially the stuff sold in Western countries. I wouldn’t worry too much about guar gum. You could always make your own, of course, if you wanted to avoid any thickeners, preservatives, or BPA from the can lining. A quarter cup gets you 1. We’ve gone over coconut flour before, so I’ll keep it brief. Use this stuff if you have a hankering for baked items. Ideally, we’d all stick to whole, real foods in their natural state, but there’s nothing wrong with the occasional Primal baked good. If it helps you maintain your eating plan without any major lapses, I’d say using coconut flour is a good compromise. Two tablespoons get you 1. Think of coconut cream as coconut milk without all the water. It’s the same stuff – pulverized coconut flesh mixed with water – but coconut cream is thicker and pastier. If you want to make a thicker coconut curry without all the added liquid, use coconut cream in place of milk. Many recipes even specifically call for coconut cream. In case you don’t have access to actual coconut cream, you can skim the thick top layer out of an unshaken, undisturbed can of coconut milk; that’s the cream. Store bought coconut cream is often sweetened, so be vigilant and scan those labels. Creamed coconut usually comes in a solid block. It may look like shortening or hydrogenated lard, but it’s not, and it may sound like coconut cream, but it isn’t. It’s pure coconut flesh, pulverized and formed into solid blocks that can be broken up into chunks and added to sauces or curries toward the end of cooking. Some claim it makes the best curries, better even than milk or cream- based ones. I haven’t tried, so I can’t verify that statement, but I am keeping my eyes peeled for creamed coconut. An ounce will get you 2. Desiccated Coconut. Desiccated coconut is unsweetened, very finely ground coconut with most of the moisture removed. This is not to be confused with coconut flour, which has the fat removed; desiccated coconut retains all the SFA goodness. Desiccated coconut is used all over for desserts, but PBers might enjoy sprinkling it over a bowl of berries and cream, onto curries, or directly into their mouths. It’s just the coconut flesh only dry, so there’s still a nice bit of subtle sweetness to desiccated coconut. An ounce will get you 1. Shredded coconut is mostly dry, but it usually retains more moisture than full- on desiccated coconut. But really, the main difference between shredded coconut and desiccated coconut (and flaked coconut, too) is the shape of the coconut. Shredded coconut comes shredded; it’s in thin strands or strips. Flaked coconut, meanwhile, comes is flatter, wider pieces. Still dry, though, and still coconut. Use shredded or flaked coconut the same way you’d use desiccated, ground coconut. Sources. Ethnic groceries, especially ones catering to Indian or Southeast Asian clientele, are the best brick- and- mortar spots for the various coconut products. They’ll usually have the most authentic products at the cheapest prices, but not everyone has access to these stores. Whole Foods and other health food spots will generally carry coconut oil, coconut milk, desiccated coconut, as well as shredded and/or flaked coconut. Maybe even coconut butter. Again, though, not everyone has access to a Whole Foods or a health food store. Trader Joe’s carries a coconut milk, but it’s “light.” Avoid these and stick to the full- fat versions. Another option is an online vendor. There are several good ones: Tropical Traditions tends to get high marks for its coconut products. Coconut oil gets most of the attention, but their “Organic Food” pull down menu has a section for other coconut stuff: flour, flakes, shredded coconut, and cream. I hear great things about the Artisana Coconut Butter, available from several different sources, including Amazon and many more. Simply Coconut is another vendor. Another good option is to just browse Amazon, which carries a ton of different coconut products, each with user reviews. Find a few, compare the ratings and reviews, read the nutrition facts, and take a chance. Word of mouth is best, though. I’m interested in hearing from readers. What are your favorite coconut products? Did I leave any out? And where do you buy your creamed coconut? What’s the best online vendor, in your opinion? Subscribe to the Newsletter. If you'd like to add.
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Indomethacin and other nonsteroidal anti- inflammatory drugs (NSAIDs) are the drugs of choice. NSAIDs are prescribed for approximately a 7- to 1. Use NSAIDs with caution or avoid them in patients in edematous states, such as heart failure, and in patients with peptic ulcer disease or renal insufficiency. Colchicine, which inhibits neutrophil activation, is effective but is currently used less frequently because of its adverse effects. Traditionally, colchicine is administered as a 0. The adverse gastrointestinal effects include abdominal pain, diarrhea, and nausea, which occur in most patients started on colchicine. Although colchicine can be administered intravenously, this is usually avoided because of its potential for serious toxicity. Use intra- articular glucocorticoids in patients with contraindications to NSAID or colchicine use. Occasionally, intra- articular glucocorticoids may be used in patients with gouty arthritis refractory to NSAIDs or colchicine. Chronic gout therapy. After the symptoms of acute gout subside, patients enter the intercritical period during which a decision must be made regarding the need for treatment with a urate- lowering medication. One important point to consider is that abrupt lowering of urate levels can precipitate an attack of acute gout during the intercritical period. Thus, these patients should receive prophylactic colchicine coverage irrespective of which urate- lowering medication is used. The choice of urate- lowering medications is uricosuric drugs (which promote uric acid excretion) or xanthine oxidase inhibitors (which inhibit uric acid production). Probenecid, which is a uricosuric drug, inhibits the tubular reabsorption of filtered and secreted urate, thereby increasing urate excretion. The ideal candidates for probenecid therapy are those with a 2. L/min). The starting dose for probenecid is 2. Some degree of gastrointestinal irritation is experienced by approximately 2% of patients. Allopurinol is the most widely used antihyperuricemic agent. The major metabolite of allopurinol is oxypurinol, and both allopurinol and oxypurinol are competitive inhibitors of the enzyme xanthine oxidase. The ideal candidates for allopurinol treatment are as follows. Uric acid overproducers (2. Patients with renal insufficiency, nephrolithiasis, or tophaceous gout. Patients at risk for developing uric acid nephropathy. Although allopurinol can be used in almost any hyperuricemic state, the above- mentioned conditions are more specific indications for allopurinol use. The usual maintenance dose for adults is 2. The long half- life of oxypurinol makes once- daily dosing possible. Very importantly, adjust the dose in persons with chronic renal insufficiency because a higher incidence of adverse effects is observed if the dose is not adjusted. Allopurinol is well tolerated by most patients, but hypersensitivity reactions may develop, which can be severe or fatal. Because a skin rash may progress to a severe hypersensitivity reaction, patients who develop a skin rash should discontinue allopurinol. Hepatotoxicity, bone marrow depression, and interstitial nephritis are rare but serious adverse effects of allopurinol. Febuxostat is an orally administered xanthine oxidase inhibitor that was approved by the US Food and Drug Administration (FDA) in 2. In the CONFIRMS trial, a 6- month study that compared febuxostat and allopurinol in 2. In patients with mild- to- moderate renal impairment, febuxostat at any dose was superior to allopurinol in lowering uric acid levels. It acts by inhibiting the urate transporter, URAT1, which is responsible for the majority of the renal reabsorption of uric acid. It also inhibits organic anion transporter 4 (OAT4), a uric acid transporter associated with diuretic- induced hyperuricemia. Lesinurad must be coadministered with a xanthine oxidase inhibitor and is indicated for hyperuricemia associated with gout in patients who have not achieved target serum uric acid levels with a xanthine oxidase inhibitor alone. It is not approved for asymptomatic hyperuricemia and it is contraindicated for increased uric acid levels caused by tumor lysis syndrome or Lesch- Nyhan syndrome. Monotherapy or higher than recommended doses are associated with an increased serum creatinine level. Renal function should be assessed before initiating therapy and periodically thereafter. More frequent monitoring is required for an estimated creatinine clearance (Cr. Cl) below 6. 0 m. L/min. Do not initiate therapy if the Cr. Cl is below 4. 5 m. L/min and discontinue if Cr. Cl decreases persistently to below 4. L/min. Approval was based on three randomized, placebo- controlled studies involving 1. Serum uric acid levels were lower in participants treated with lesinurad plus allopurinol or febuxostat than in those who received placebo in combination with a xanthine oxidase inhibitor. It is approved for use in adults with chronic gout that is refractory to conventional therapy. It is administered by intravenous infusion. Uric acid nephrolithiasis. Allopurinol is the mainstay of drug therapy in patients with hyperuricemia who develop uric acid stones. Patients with calcium stones who are hyperuricosuric may also benefit from allopurinol because urate crystals in the urine may act as a nidus for other stones to form. Potassium citrate and occasionally sodium bicarbonate or acetazolamide may be required to alkalinize the urine and to increase the solubility of uric acid. Adequate hydration is recommended to maintain a high urine output of at least 2 L daily, unless otherwise contraindicated for other medical conditions where volume overload may be a concern. Uric acid nephropathy. Over the years, efforts to prevent uric acid nephropathy, especially in the oncological setting, have resulted in a decrease in mortality from uric acid nephropathy. Intravenous hydration with saline and the administration of furosemide or mannitol (to dilute the urine) are necessary to prevent further precipitation of uric acid. Alkalinizing the urine with sodium bicarbonate or acetazolamide may be necessary to further enhance uric acid elimination. Rasburicase (Elitek), a recombinant urate oxidase, is approved for use in preventing complications of hyperuricemia during the tumor lysis syndrome in both adults and children. It facilitates the conversion of urate to a more soluble product, allantoin. Although rasburicase treatment has become the standard of care for patients at high risk of tumor lysis syndrome, debate continues on whether the profound and rapid lowering of plasma uric acid levels produced by rasburicase has a significant effect on patient outcomes (eg, need for renal replacement therapy and mortality). If acute renal failure develops despite these measures, then early hemodialysis is indicated to reduce the total body burden of uric acid, thereby facilitating recovery of renal function. |
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October 2017
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