A: At this time there are no studies on using probiotics in those taking Coumadin (warfarin). This month in the Swedish journal Lakartidningen the question came up and they also reviewed the literature, finding no evidence for or against.

The issue is that such bacteria produce Vitamin K as part of their digestion process. As such, taking probiotics could, in theory, affect your INR by providing a greater population in your gut. Probiotics and Coumadin (warfarin)

Q: Can you shed any light on the benefits or misconceptions of agave nectar especially as it relates to Type II diabetics and the glycemic index? Is it just a bunch of hype or can agave nectar (when used properly) be a useful and safe dietary sweetener?

A: I haven’t used agave nectar in years. It was somewhat popular in the early eighties when I was involved in managing a chain of healthy fast food restaurants. I didn’t use it much in cooking but we served it as an alternative sweetener. In the last few years it has been marketed heavily as an alternative to sugar.

The reason for this is that it is very sweet but has a low Glycemic Index (GI). You can think of GI is a measure of how a particular food is processed by the body. In essence, it measures the rise in blood glucose of a 10 to 50 gram carbohydrate equivalent of a food as compared to the same number of carbohydrate gram equivalents of glucose. Agave Nectar

Q: I was watching CSI tonight and learned that peach pits contained cyanide. I started checking into it on the internet and found out it is true. I assume it would take a lot of pits to be deadly. My question is in regard to an old family recipe for peach pit jelly. I make this jelly every summer from the skins and pits of the peaches that I can. I cover them in water and cook them down for about 20 to 30 minutes, strain the juice and make jelly. We have always eaten this jelly and seem to be okay, but are we in any danger from this?

A: Peach pits do contain “cyanide” but it’s in a form called amygdalin. You can find out about this here: Peach Pits and Cyanide

I have searched for information regarding making the jelly from the peach pits and skins and can’t find any information that it is dangerous. The fact that you and others have been making it for years and have not had any adverse effects is comforting. I can’t find any report of people having problems with peach pit jelly.

Q: I am 5 foot 5 and 58 years old. After topping the scales at 178 pounds, I finally got serious about getting into shape and losing weight, about two months ago. I work out vigorously five to six days a week for an average of one and a half hours to burn off 500 calories per session, cut an average of 400 calories a day from my diet, and am living a more active life in general. After two months, I expected to have at least lost the ten pounds I’d gained over the past year, but although I have firmed up and built muscle, I’m disheartened that I’ve lost only five pounds. It seems that for all my work I should have had better results.

A: This is fantastic and you should not do anything different that you have done. We know that long term, sustained, healthy weight loss should be a slow, steady process and the 5 pounds you have lost in two months is perfect. There’s great research to show that optimal weight loss should be in the two to four pound per month range so at 5 pounds you are right on target. Working Hard, but Not Losing

Q: I would like to know how much cooked fresh garlic per day I can use. For example, if I chop half an average size clove to season two pork chops, then pan fry them and add the marinating sauce with the garlic and simmer the chop in it for about 5 minutes. Would that cause me to bleed if I am on 5 mg of Coumadin daily?

A: There’s no evidence that garlic will have any effect whatsoever on blood clotting or the effectiveness of Coumadin (warfarin). Eat all you like (or your significant other can tolerate on your breath).

Dear Dr. Gourmet,

Q: I am very worried about my father’s health. He eats a hamburger, french fries and Coke almost every day and he rarely eats any vegetables. He has incredibly high cholesterol and blood pressure, type II diabetes, liver and kidney problems and an alleged potassium deficiency that occasionally causes his legs to not be able to support his weight.

He claims that all of his health issues are hereditary and not influenced by his diet. I do not believe that.

What evidence can I use to convince him that his diet is unhealthy and is likely contributing to his health problems?

A: Well, I’d like to think that you’ve come to the right place.

Your father could not be more wrong about health issues being only hereditary. There is clearly a factor of how our family history can and does affect our health but this can certainly be overcome by eating healthy and maintaining a reasonable weight. The best place for you to get started….

Q: My husband went on Coumadin this week and one of the doctors told him, “NO cranberries.” When we read how low the vitamin K is in cranberries, we questioned this.

The nurse researched it for us and was told that cranberries kill some type of bacteria in your body and that the bacteria affecst the Coumadin. Is this correct?

A: Well, my standard answer for this has been to send folks to an article written for the Dr. Gourmet website back in 2006.

After reading your email I decided it was time to revisit this. There wasn’t good science about the issue of an interaction between cranberry juice and Coumadin (warfarin). The good news is that we now have pretty good evidence that it’s OK to drink cranberry juice.

Q: My family and I picked some wild mushrooms (what in our area, Northern MI are called beefsteak mushrooms or false morels) and are wondering how safe they are to eat? Some say not at all, others say if you cook them correctly. So my question is how would I prepare and cook them to be safe?

A: You do have to be very, very careful if you are going to eat wild mushrooms. Some, like the morels that I used to get in Virginia, are easy to know whether they are safe or not. There are a number of resources for you.

Dear Dr. Gourmet,

Q: I’ve been following a Weight Watchers type diet for 2 1/2 months now. I’m 44 yrs old, 5′4″ and weigh just over 150 lbs. In the past, as recently as last year, I have been able to go a month or two with a WW type diet and lose 5 lbs minimum. This time I have not been able to lose even 1/2 lb.

I have really been careful about sticking to eating well, but I feel at a real loss right now and don’t know what to do next. Any advice you can offer to help me lose weight would be appreciated. What would you advise as the next steps?

A: This is a great question. There’s some evidence that as we get older – into our 40s and 50s – that it can be more difficult to lose weight. Everyone is different, of course, and there’s been some research focusing on this but nothing conclusive as to the actual cause. What we do know….

Q: What are the effects of the following herbs on my Coumadin and my INR (warfarin): burdock root, echinacea, and gotu kola?

A: No one knows for sure the effects of these herbs would be on INR for folks who take Coumadin (warfarin). There’s no health benefit for anyone that’s been proven for any of these, so there’s no reason to take them and no reason to take the risk.

Q: Does papaya help to lose weight? How does papaya help our immune system?

A: There is no evidence that papaya is anything more than a good fruit. It is not a magical weight loss fruit as some might have you believe. There is no secret about papaya that will boost your immune system beyond the fact that it is simply a fruit. Papaya

Q: My husband had Aortic Valve Replacement 10-11-05 at the age of 27. He has a St. Jude Mechanical Valve – therefore he is on Coumadin and of course has to have his INR checked regularly. He is very concerned about his weight. He gained about 25 – 30 pounds after the surgery. He has maintained that weight since the surgery but he would like to lose it.

I have no idea what to do for him – or what he can do for himself. I have to cook for 3 boys, my husband and myself, so it is difficult to know what to prepare that won’t cost an arm and a leg! I don’t fry foods, and most everything I cook is prepared with low-fat, low cholesterol items. He still doesn’t lose weight, and I wonder if it is due to the medications he is on.

A: The key to your husband’s weight loss, as with all weight loss, is a matter of eating fewer calories and burning more.

Folks who are taking Coumadin (warfarin) can feel that this is a challenge because they believe that they are limited in what they can eat. In truth….

Dr. Tim Says….

I have written before about the interaction with certain medications and grapefruit. It wasn’t until about 2 years ago that scientists identified the exact substance in grapefruit that causes the problem. We now know that furanocoumarins (naturally-occurring substances found in grapefruit’s juice) are the culprit.

The issue is how those furanocoumarins interact with the CYP3A4 enzyme made in the liver. The problem arises because of the way this enzyme acts on certain medications. Drinking grapefruit juice affects this enzyme and interferes with how they are broken down. We don’t know exactly how long after eating grapefruit or drinking the juice the effect wears off, however. Consequently the ongoing presence of the grapefruit in the body continues to have an effect on the system.

Interestingly, there are also CYP3A4 enzyme produced in the intestine that can interfere with the availability of drugs being absorbed into the bloodstream. As a result you should be aware that there may not be a safe time to take some medications when eating grapefruit or drinking grapefruit juice.

One of the questions that I have received after writing on this topic is just which drugs can be a problem. Grapefruit Interactions

Featured Recipe

Trout with Tarragon Mustard Sauce

I like serving trout in filets because I am not all that fond of fighting with my food when I am ready to eat it. Most trout filets have been boned before you buy them, but check carefully before cooking. The key to cooking is a pan that’s quite hot but not so hot as to scorch the fish. Place the filets in skin side down to sear and then reduce the heat. The skin will crisp up nicely and the fish will cook easily.

This recipe is Coumadin® (warfarin) safe and gluten free provided that the ingredients used to make it are gluten free. Those who are lactose intolerant or have GERD / Acid Reflux should avoid it.

Taste Buds

There are five types of receptors on the tongue that sense all of the flavors that we taste. They are salt, sweet, bitter, sour and one called umami. Umami is a taste receptor that was identified only about six years ago and is best described as savory.

Each of these flavors acts on their own, but how they interact with each other is key to making recipes taste fantastic. Activation of any one taste will enhance another taste bud.

Sour
Sour tastes come from acidic foods. Because of the properties of acidic foods and how fast they react on the sour taste buds, these flavors can quickly brighten an otherwise dull dish.

The properties of salt react with acids and soften the bitterness of dishes. In doing so, sweetness is enhanced. Taste Buds

Eat well, eat healthy, enjoy life!

Timothy S. Harlan, M.D.
Dr. Gourmet