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  From the Desk of Editor–in–Chief
Dr KK Aggarwal

Padma Shri and Dr B C Roy National Awardee
Dr KK Aggarwal
President, Heart Care Foundation of India; Sr Consultant Physician, Cardiologist & Dean Medical Education Moolchand Medcity; Chairman Ethical Committee Delhi Medical Council; Chairman (Delhi Chapter) International Medical Sciences Academy; National Vice President Elect Elect, Indian Medical Association; Hony Director IMA AKN Sinha Institute (08–09); Hony Finance Secretary National IMA (07–08); Chairman IMA Academy of Medical Specialties (06–07); President Delhi Medical Association (05–06), President IMA New Delhi Branch (94–95, 02–04); Editor in Chief IJCP Group & Hony. Visiting Professor (Clinical Research) DIPSAR

For updates follow at www.twitter.com/DrKKAggarwal     www.facebook.com/Dr KKAggarwal

    Health Videos…
Nobility of medical profession Video 1 to 9 Health and Religion Video 1 to 7
DD Take Care Holistically Video 1 to 7 Chat with Dr KK On life Style Disorders
Health Update Video 1 to 15 Science and Spirituality
Obesity to Towards all Pathy Consensus ALLOVEDA: A Dialogue with Dr KK Aggarwal

12th October 2012, Friday

Coffee Tied to Glaucoma Risk in United States

Heavy consumption of caffeinated coffee is associated with an increased risk for exfoliation glaucoma (EG) or exfoliation glaucoma suspect (EGS), especially in women with a family history of glaucoma, according to a study published in the October issue of Investigative Ophthalmology and Visual Science, reports Medscape.

For More editorials…

Dr KK Aggarwal
Group Editor in Chief

    Carnitine Update


  • Deficiencies in thiamine, selenium and L-carnitine have been reported to produce heart failure and replacement therapy results in improvement in cardiac function.
  • Carnitine deficiency impairs the oxidation of fatty acids, resulting in lipid accumulation in the myocyte cytoplasm. This problem is reversed with L-carnitine replacement.

What is the etiology of dilated cardiomyopathy?

There are several causes of dilated cardiomyopathy.

  • Idiopathic (50%)
  • Myocarditis (9%)
  • Ischemic heart disease (7%)
  • Infiltrative disease (5%)
  • Peripartum cardiomyopathy (4%)
  • Hypertension (4%)
  • HIV infection (4%)
  • Connective tissue disease (3%)
  • Substance abuse (3%)
  • Doxorubicin (1%)
  • Others (10%)

For Comments and archives…

Dr K K Aggarwal
  eMedinewS Audio PostCard

Stay Tuned with Padma Shri and Dr BC Roy National Awardee Dr KK Aggarwal

A soda a day raises heart disease risk by 20%

Audio PostCard
    Photo Feature (From HCFI Photo Gallery)

19th MTNL Perfect Health Mela to train 10,000 people in compression only CPR

Addressing a press conference, Padma Shri & Dr. B.C. Roy National Awardee, Dr. KK Aggarwal, President Heart Care Foundation of India said that more than 10,000 members of the public will be certified in compression only CPR during the Mela.

Dr K K Aggarwal
    National News

Atopic Allergies: The Way Forward

Dr. Dang’s Lab organized an interactive medical symposium on “Atopic Allergies: The Way Forward” on October 7, 2012, with an aim to generate an awareness amongst the doctors and masses alike, about allergy, its diagnosis and management.

The faculties for the session were eminent and distinguished specialists from their respective fields. The symposium was introduced by Dr. Arun Agarwal (Dean, Maulana Azad Medical College (MAMC), New Delhi and President, Delhi Medical Council), followed by an interesting talk on “Modalities & Management of Allergic Rhinitis” by Dr. Achal Gulati (Director & Professor - ENT, MAMC, New Delhi). Dr. Arvind Taneja (Senior Consultant Pediatrician, Max hospital, New Delhi) spoke on “Pediatric Allergies: A current Perspective”. Dr. V.K. Sharma (Professor & Head, Dept. of Dermatology, AIIMS, New Delhi), gave an enlightening talk on Atopic Dermatitis while Dr. Randeep Guleria (Professor & Head, Dept. of Pulmonary Medicine & Sleep Disorders), shared his views on “Allergies & Respiratory Disorders”.

The Symposium was followed by a panel discussion. The panelists comprised of the distinguished speakers in the symposium along with Dr. Rajiv Khosla (Senior Consultant Physician & Senior Gastroenterologist with various reputed hospitals of Delhi), Dr. Navin Dang (Director - Dr Dang’s Lab) and Dr Biswajit Sen (Senior Consultant Cytohisto- Pathology at Dr Dang’s Lab).

The audience comprised of more than 250 doctors, an interesting mix of internists, pediatricians, pulmonologists, and dermatologists.

The inquisitive, enthusiastic and intelligent audience of both young and experienced doctors were full of questions during the panel discussion, each of which was patiently heard and answered by the panelists, which goes on to prove that the topic of Allergy is still an enigma.

In conclusion, everyone agreed that allergic disorders are on the rise and need to be precisely diagnosed so that appropriate management is initiated at the earliest. Everybody appreciated the introduction of Phadiatop allergy screening test and symptom-based specific IgE panels against specific geographically, area-based, researched allergens performed by internationally acclaimed Immunocap technology to rule out atopy.

Why ImmunoCap? (vs Skin Prick Test)

  • Totally safe
  • Standardization and reproducible
  • No patient/procedure variation
  • No drug interactions
  • Not dependent on skin condition
  • Quantitative-Decision points possible
  • Better patient’s acceptance
  • US FDA approved
  • Calibrated to WHO standards
  • Used by 85% of labs performing allergy tests globally.

My Profession My Concern
(Mr Vivek)

How prices are decided in other countries

To help those who may wish to understand the way I think is personal experience when my son was born in Australia where we had to pay the entire amount as we were not citizens and also were not covered by insurance we had, due to minimum 3-year stay clause.

We were offered only two prices

  1. ABC amount - if all goes well without any complication and normal delivery and if there is anything going wrong the bill will start building dependent on the services rendered for potentially safer and positive outcome
  2. XYZ amount - whatever happens whether normal or with any kind of complication their will be flat charge of XYZ which will not go up by a single penny and the best will be provided whatever may happen

To help those who may wish to understand the way I think is personal experience when my son was born in Australia where we had to pay the entire amount as we were not citizens and also were not covered by insurance we had, due to minimum 3-year stay clause.

The XYZ amount was approx 30% extra than of ABC amount.

For comments and archives

Medical mistakes in Indian movies

Dear all, eMedinewS is starting a special series on ‘Medical mistakes in Indian movies’. We invite all our readers to share with us the following information:

  1. Scene/s where the image of the medical profession has been maligned in an unrealistic manner, or
  2. Scene/s where medical care and approach has been depicted incorrectly, or
  3. Scenes where the medical profession has been portrayed correctly.

Send us the clippings or description of the scenes. This would be a start to a special campaign to rebuild the image of the medical profession.

Certificate courses in 2D and 3D Echocardiography/Fellowship Diploma in non invasive cardiology Contact Dr KK Aggarwal, Moolchand Medcity, email: emedinews@gmail.com

    Valvular Heart Disease Update

Preventing valvular endocarditis

The following are the highest risk conditions

  • Prosthetic heart valves, including bioprosthetic and homograft valves.
  • A prior history of IE.
  • Unrepaired cyanotic congenital heart disease, including palliative shunts and conduits.
  • Completely repaired congenital heart defects with prosthetic material or device, whether placed by surgery or by catheter intervention, during the first six months after the procedure.
  • Repaired congenital heart disease with residual defects at the site or adjacent to the site of the prosthetic device.
  • Cardiac valvulopathy in a transplanted heart.

(Experts: Dr Ganesh K Mani, Dr Yugal Mishra, Dr Deepak Khurana, Dr Rajesh Kaushish, Dr K S Rathor, Dr Sandeep Singh and Dr KK Aggarwal)

For comments and archives

    International News

(Contributed by Dr Monica and Brahm Vasudev)

2012 Nobel Prize for chemistry

Robert Lefkowitz, a professor at Duke University, and Brian Kobilka, Professor of Medicine, and Professor of Molecular and Cellular Physiology at Stanford were awarded the 2012 Nobel Prize in Chemistry. Their work focused on discovering the inner workings of G-protein-coupled receptors, gateways to cells that react to chemical messages. The prize committee said that around half of all medications act through these receptors, including beta blockers, antihistamines and various kinds of psychiatric medications.

For comments and archives

Study finds best drugs to slow premature birth

Prostaglandin inhibitors such as celecoxib (Celebrex) and indomethacin (Indocin), and to a lesser extent calcium channel blockers such as nifedipine and nicardipine (Cardene), were best at stalling premature labor, a meta-analysis showed. (Source: Medpage Today)

For comments and archives

Vaginal mesh removal difficult and may not relieve pain

Removal of vaginal mesh results in complete resolution of pain and dyspareunia in 45.6% of patients. Mesh erosion can be found in the bladder, bowel, or other regions of the vagina, and, therefore, these areas should be evaluated during mesh removal. Erin C. Crosby, MD, from the University of Michigan in Ann Arbor, presented her paper at the American Urogynecologic Society (AUGS) 33rd Annual Scientific Meeting. (Source: Medscape)

For comments and archives

Conversion from depression to bipolar higher early postpartum

The first 6 months postpartum carry a significantly higher risk for women with major depressive disorder (MDD) to convert to bipolar disorder (BD) compared with other times in their lives, new research shows. The findings highlight the impact that fatigue and hormonal fluctuations may have in this vulnerable population, said lead investigator Verinder Sharma, MD, during a poster presentation here at the Canadian Psychiatric Association (CPA) 62nd Annual Conference. (Source: Medscape)

For comments and archives

   Twitter of the Day

@DrKKAggarwal: Apples Reduce Oxidized LDL http://blog.kkaggarwal.com/2012/10/apples-reduce-oxidized-ldl/ …

@DeepakChopra: My intent is to facilitate the emergence of self-organizing dynamic networks of connected souls.

    Spiritual Update

(Dr KK Aggarwal, Group Editor in Chief, IJCP Group of Publications and eMedinews)

Was Lord Ganesha born of an induced pluripotent stem cell transplant?

Today, the West claims that they can create human bladder tissue from the human skin cells. But was not lord Ganesha created by Parvati from the dirt of her body? The dirt from allopathic point of view would equate to the cells of her skin. In today’s terms, Ganesha birth can be explained as the origin of stem cell baby birth in literature.

For comments and archives

    4th Asia Pacific Vascular Intervention Course (APVIC)
  • 4th Asia Pacific Vascular Intervention Course–Excerpts from a Panel discussion Read More
  • The 4th Asia Pacific Vascular Interventional Course begins Read More
  • Excerpts of a talk and interview with Dr. Jacques Busquet by Padma Shri & Dr. B.C. Roy National Awardee, Dr. KK Aggarwal, President Heart Care Foundation of India and Editor–in–Chief Cardiology eMedinewS Read More
  • 4th Asia Pacific Vascular Intervention Course – Dr KK Aggarwal with Faculty Read More
  • Press Conference on 4th Asia Pacific Vascular Intervention Course – Dr KK Aggarwal with Faculty Read More
  • 4th Asia pacific vascular intervention course Read More
  • 4th Asia pacific vascular intervention course paper clippings Read More
    Infertility Update (Dr Kaberi Banerjee, IVF expert, New Delhi)

Is fertility possible after cancer treatment?

  • Men. If sperm counts are consistently low, insemination, IVF, and ICSI may be effective measures for achieving pregnancy. Testicular biopsy may be a way to obtain sperm if sperm are not found in a semen analysis. If sperm cannot be obtained, pregnancy may be possible by using frozen donor sperm.
  • Women: Many women will be able to conceive naturally or with fertility treatments. If signi?cant damage has occurred to the ovaries or uterus, couples may wish to consider egg or embryo donation, a gestational carrier, or adoption to create a family.

For comments and archives

    Tat Tvam Asi………and the Life Continues……

(Dr N K Bhatia, Medical Director, Mission Jan Jagriti Blood Bank)

Blood Donation - Gift of Liquid Love

But it was found that many other organisms like non-a non-B hepatitis virus (called as Hepatitis C and D viruses), Cytomegalovirus (CMV), EB virus, were also responsible for post transfusion hepatitis.

For comments and archives

    Liver Abscess Update

(Dr Neelam Mohan, Director, Dept. of Pediatric Gastroenterology, Hepatology & Liver Transplantation Medanta – The Medicity Hospital)

What is the treatment of amoebic liver abscess and duration?

Metronidazole is the drug of choice for amebic liver abscess. It is prescribed for 10 to 14 days.

For comments and archives

   An Inspirational Story (Ms Ritu Sinha)

The goldfish bowl – cute!

Have you ever been saved from embarrassment by a kindly soul who absorbs the ridicule? These are the kind of people who are friends for life. Check this story out.

There is a nine-year-old kid sitting at his desk and all of a sudden, there is a puddle between his feet and the front of his pants are wet. He thinks his heart is going to stop because he cannot possibly imagine how this has happened. It’s never happened before, and he knows that when the boys find out he will never hear the end of it. When the girls find out, they’ll never speak to him again as long as he lives.

The boy believes his heart is going to stop; he puts his head down and prays — “Dear God, this is an emergency! I need help now! Five minutes from now I’m dead meat.” He looks up from his prayer and here comes the teacher with a look in her eyes that says he has been discovered.

As the teacher is walking toward him, a classmate named Susie is carrying a goldfish bowl that is filled with water. Susie trips in front of the teacher and inexplicably dumps the bowl of water in the boy’s lap. The boy pretends to be angry, but all the while is saying to himself, “Thank you, Lord! Thank you, Lord!”

Now all of a sudden, instead of being the object of ridicule, the boy is the object of sympathy. The teacher rushes him downstairs and gives him gym shorts to put on while his pants dry out. All the other children are on their hands and knees cleaning up around his desk. The sympathy is wonderful. But as life would have it, the ridicule that should have been his has been transferred to someone else – Susie.

She tries to help, but they tell her to get out. “You’ve done enough, you klutz!” Finally, at the end of the day, as they are waiting for the bus, the boy walks over to Susie and whispers, “You did that on purpose, didn’t you?” Susie whispers back, “I wet my pants once too.”

May God help us see the opportunities that are always around us to do good.

For comments and archives

   Cardiology eMedinewS

Duloxetine beats pregabalin for diabetic neuropathy Read More

Early smoking stunts life Read More

   Pediatric eMedinewS

DITPA active against crippling MCT8 deficiency in kids Read More

Fresh blood cells no better for preemies Read More

    IJCP Special

Dr Good Dr Bad

Situation: A 32–year–old man with sustained fever of 102°F for 2 weeks with no apparent diagnosis after 3 days of diagnostic studies is hospitalized.
Dr Bad: Manage him as a case of PUO.
Dr Good: Investigate further. Don’t diagnose PUO yet.
Lesson: Pyrexia of unknown origin (PUO) is said to occur in patients with sustained fever of 101°F or more for 3 weeks in whom the diagnosis is not apparent after one week of diagnostic studies.

For comments and archives

Make Sure

Situation: A patient on amlodipine developed severe gum hypertrophy.
Reaction: Oh my God! Why was amlodipine not stopped?
Lesson: Make sure that all patients on amlodipine are watched for gum hypertrophy as its side effect.

For comments and archives

    Lab Update (Dr Navin Dang and Dr Arpan Gandhi)

A/G ratio

  • Globulin is increased disproportionately to albumin (decreasing the albumin/globulin ratio) in states characterized by chronic inflammation and in B–lymphocyte neoplasms, like myeloma and Waldenström’s macroglobulinemia. More relevant information concerning increased globulin may be obtained by serum protein electrophoresis.
  • Decreased globulin may be seen in congenital or acquired hypogammaglobulinemic states. Serum and urine protein electrophoresis may help to better define the clinical problem.
    Microbial World - The Good and the Bad They Do

(Dr Usha K Baveja, Prof. and Senior Consultant Microbiology, Medanta – The Medicity)

Human Papillomavirus (HPV) vaccines: The dilemma “To Give or Not to Give”

HPV disease burden

More than 100 Human papilloma viruses (HPVs) genotypes are known, of which approximately 40 infect the anogenital region and around 13 are considered high risk, associated with anogenital and oropharyngeal cancers. The Human Papilloma Viruses spread by skin-to-skin contact during sexual activity with another person. One can carry HPV without knowing it, without manifesting any symptoms, so it is possible to unknowingly spread HPV to another person. Estimated worldwide HPV prevalence is 9-13% i. e. around 630 million people are already infected and approximately 6 million people are being infected each year. The prevalence of HPV increases with age from 14 to 24 years and then declines. Up to 80% of women will acquire an HPV infection in their lifetime. Majority of HPV infections are transient and subclinical and undergo subsequent clearance by the immune system. Persistence of infection results in development of anogenital warts as well as precancerous lesions and cancers.

The worrying facts

HPV types 16 and 18 are known to cause about 70% of all cases of invasive cervical cancer. HPV 16 has the greatest oncogenic potential and continues to be the dominant oncogenic type worldwide. Other oncogenic HPV types include HPV 31, 33, 35, 45, 52, and 58. All these HPVs have been associated and are said to cause cancers, including: cervical, vulvar, vaginal, penile, anal, and oropharyngeal cancers. HPV infection is considered to contribute to almost 100% cervical cancers and at least 80% of anal and 40-60% of vulvar, vaginal and penile cancers. In India, HPV 16, 18, 31, 33, and 45 account for more than 90% of cervical cancer cases. Certain HPV types also cause genital warts in men and women (Ind J STD 2011;32(2):75-85)

Way forward – Need for HPV vaccine?

In view of the morbidity and mortality associated with genital HPV, there is a need to protect the adolescents and adults from this infection. Immunity conferred by natural infection is low compared to prophylactic HPV vaccines. The commercially available vaccines prepared from purified L1 structural proteins by recombinant technology. These proteins self-assemble to form virus-like particles (VLPs) which lack the nucleic acid and do not cause infection but induce a protective host immune response which is much stronger, long lasting, and includes partial cross-protection to non-vaccine-related serotypes. This is due to high immunogenicity of VLPs inducing much higher concentrations of neutralizing antibodies to L1, higher antigen dose in VLPs, and direct exposure of capsids to systemic immune responses.¬ HPV vaccines are for prophylactic use only; they do not clear existing HPV infection or treat HPV-related disease.

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Photos and Videos of 3rd eMedinewS – RevisitinG 2011 on 22nd January 2012

Photos of Doctor’s Day Celebration

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  Quote of the Day (Dr GM Singh)

A mountain is not higher than our confidence. It will be under our feet if we reach the top.

    Mind Teaser

Read this…………………

A client with head injury is confused, drowsy and has unequal pupils. Which of the following nursing diagnosis is most important at this time?

A. Altered level of cognitive function
B. High risk for injury
C. Altered cerebral tissue perfusion
D. Sensory perceptual alteration

Yesterday’s Mind Teaser: The nurse includes the important measures for stump care in the teaching plan for a client with an amputation. Which measure would be excluded from the teaching plan?

A. Wash, dry and inspect the stump daily.
B. Treat superficial abrasions and blisters promptly.
C. Apply a "shrinker" bandage with tighter arms around the proximal end of the affected limb.
D. Toughen the stump by pushing it against a progressively harder substance (e.g., pillow on a foot-stool).

Answer for yesterday’s Mind Teaser: C. Apply a "shrinker" bandage with tighter arms around the proximal end of the affected limb.

Correct answers received from: YJ Vasavada, Dr Parimal Shah, Dr Pankaj Agarwal, Dr Jainendra Upadhyay, Dr KV Sarma, Dr Ajay Gandhi, Dr Chandresh Jardosh, Dr K Raju, Muthumperumal Thirumalpillai, Dr Thakor Hitendrsinh G, Dr Kanta Jain.

Answer for 9th October Mind Teaser: D. Ineffective airway clearance related to muscle weakness
Correct answers received from: Dr K P Chandra.

Send your answer to ijcp12@gmail.com

    Laugh a While (Dr. GM Singh)

A Modern Panchtantra story

Once upon a time, there was a software engineer who used to develop programs on his Pentium machine, sitting under a tree on the banks of a river. He used to earn his bread by selling those programs in the Sunday market. One day, while he was working, his machine tumbled off the table and fell in the river. Encouraged by the Panchatantra story of his childhood (the woodcutter and the axe), he started praying to the River Goddess. The River Goddess wanted to test him and so appeared only after one month of rigorous prayers. The engineer told her that he had lost his computer in the river.

As usual, the Goddess wanted to test his honesty. She showed him a match box and asked, "Is this your computer?" Disappointed by the Goddess's lack of computer awareness, the engineer replied, "No."

She next showed him a pocket-sized calculator and asked if that was his.

Annoyed, the engineer said "No, not at all!!" Finally, she came up with his own Pentium machine and asked if it was his.

The engineer, left with no option, sighed and said "Yes."

The River Goddess was happy with his honesty. She was about to give him all three items, but before she could make the offer, the engineer asked her, "Don't you know that you're supposed to show me some better computers before bringing up my own?"

The River Goddess, angered at this, replied, "I know that, you stupid donkey! The first two things I showed you were the Trillennium and the Billennium, the latest computers from IBM!". So saying, she disappeared with the Pentium!!

Moral: If you're not up-to-date with technology trends, it's better to keep your mouth shut and let people think you're a fool than to open your mouth and remove all doubt.

    Medicolegal Update

(Dr Sudhir Gupta, Additional Prof, Forensic Medicine & Toxicology, AIIMS)

Immediate first aid may stop serious poisoning and may save life

In cases of poisoning, if breathing and the heart stop, the person will die within a few minutes unless first aid is given at once. Here is an action list. Each step is explained in more detail below the list. Start with the first step and follow each step in the order given. Act as quickly as you can, but stay calm.

  • Check if the patient is conscious try to make the patient wake up. Shout "Are you all right?" and gently shake the shoulders, but take care not to make any injuries worse. Pinch the skin on the neck and watch the face. A patient who is just sleeping will wake up, but an unconscious patient will not.
  • Open the airway. The airway is the tube through which air passes from the mouth and nose to the lungs. If it is blocked the patient cannot breathe and air cannot get into or out of the lungs. A patient who cannot breathe will die within four minutes. In an unconscious patient the tongue may block the throat and the airway. Make sure the airway is open and air can get down the throat. Place the patient on his or her back. Tilt the head back and lift the chin up with the finger and thumb of one hand on the bony part of the chin, while pressing the forehead back with the other hand. This will open the airway and stop the tongue blocking the throat.
  • Check whether the patient is breathing after opening the airway; quickly check whether the patient is breathing. Look for the belly or the chest moving up and down. Feel the chest moving up and down. Feel the patient’s breathe on your cheek. Listen for breath sounds. Put your ear close to the patient’s mouth. Use all four checks. Remember that the chest may move up and down even when the throat is completely blocked and air cannot get to the lungs.

For comments and archives

    Public Forum

(Press Release for use by the newspapers)

Singhara flour – a favorite Navratra diet

Wheat flour should not be used during Navratra fasts, it should instead be replaced by either water chestnut (Singhara flour) or buckwheat flour (kuttu flour) said Padma Shri and Dr B C Roy National Awardee Dr K K Aggarwal President Heart care Foundation of India and MTNL Perfect Health Mela.

Singhara is not a cereal but a fruit and hence is a good substitute for Navratra fasts where cereals are not to be eaten.

  • Singhara flour is made from Singhara or Water Chestnuts.
  • Water Chestnuts are floating annual aquatic plants, growing in slow-moving water up to 5 meters deep. The plant bear ornately shaped fruits containing a single very large starchy seed.
  • The seeds or nuts are boiled and sold as street side snack or eaten raw.
  • The flour is made from dried, ground water chestnuts. The nuts are boiled, peeled, dried then ground into flour. The flour is a bright white fine powder; it is actually a starch rather than flour.
  • The flour is primarily used as a thickener.
  • The flour is used as a food during Navratras and consumed as a phalahar (fruit) diet.
  • It is an excellent source of energy and provides 115 kcals per 100g.
  • The glycemic index for chestnut is 60. Low GI foods have a GI value less than 55; medium GI foods have a GI value between 55 and 69 and high GI foods have GI value greater than 70.
  • Chestnuts are relatively low in net carbs (total carbohydrate minus dietary fiber). They are included in many low carb diets.
  • A gluten-free product, chestnut flour is a cooking option for people with celiac disease or other gluten intolerances or allergies.
  • Chestnuts do not contain the fat that regular nuts have.
  • Chestnut flour contains less carbohydrate than white flour.
  • People with tree nut allergies should take care to avoid chestnut flour. It may cause an allergic reaction
  • Flour made from chestnuts is typically more difficult to locate in many areas; also it is more expensive than white flour
  • Avoid eating deep fried pooris or paranthas made from the chestnut flour.
  • Do not use transfats vegetables oils to cook bread made of chestnut flour.
  • Buy only branded flour as left over flour (from last year) can lead to food poisoning.
  • As per Ayurveda, chestnut flour has cooling and buckwheat flour has hot properties
  • Both chestnut flour and buckwheat flours can be combined.
  • One should eat phalahar once a week and for at least 80 days in a year.
    Readers Response
  1. Dear Sir, emedinews is really very informative. Regards:Dr Dipti
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