Sally K. Norton

Vitality Coach, Speaker & Health Consultant

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Caribbean Avocado Soup

Creamy and hearty. This soup should be served right after preparation, as the avocado can discolor.

Caribbean Avocado Soup

  • Servings: 2
  • Time: 1 hour
  • Difficulty: Not too hard
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Ingredients

2 ripe avocados, 2 C homemade chicken bone broth, 1 T lime juice, plus 1 tsp for garnish, ¼ tsp. allspice, ¾ tsp. salt, 1/4 tsp. white pepper, pinch cayenne pepper,
½ C yogurt or coconut milk
8 sprigs of cilantro, chopped

Instructions

  1. Cut the avocados in half lengthwise. Cut off about 1/8 of the avocado, lengthwise, for use as a garnish.
  2. Sprinkle avocado garnish slice with lime juice to prevent browning.
  3. Scoop out the flesh of the remaining avocados. Place avocado into a blender with one cup chicken broth. Blend.
  4. Add the lime juice, seasonings, yogurt, and the remaining chicken broth. Blend.
  5. Chill in the refrigerator for 10 minutes.
  6. To serve, pour into bowl and set avocado slices on top as a garnish.

Bowl of green soup with avacado garnish

Bowl of green soup with avocado garnish

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Party Watermelon Seeds

Here are two ways to turn watermelon seeds into a party food and appealing snack.

Hot and Sour Watermelon Seeds

Hot and Sour Watermelon Seeds

Ingredients

3 T lime juice (2 limes)

1 T organic sugar

1 tsp. Coconut oil

1/4 – 1/2 tsp. cayenne pepper

1 C (115 grams) salted, sprouted watermelon seeds (Go Raw Brand)

1/4 tsp. allspice extract (opt.)

Instructions

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Preheat oven to 325 degrees F.

In a saucepan over med-low heat, boil the lime juice until reduced to 1 T or less (about 1 minute)

Add the sugar, coconut oil, and cayenne pepper, stir to dissolve the sugar. Turn off the heat.

Add watermelon seeds and, if using, the allspice extract. Toss until dry looking.

Spread on a parchment paper lined baking sheet pan. Bake at 325 until lightly browned and dry, about 10 minutes.

Spicy Rosemary Watermelon Seeds
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These are a quick and easy snack or party food, good for a large crowd. They will keep in the fridge for a week, or in the freezer for several months. These are so easy to make, you will want to listen to an audio book while making them. This version was inspired by Sally Fallon’s Rosemary Walnuts which was a favorite before I cut back on the oxalates in my diet.

Spicy Rosemary Watermelon Seeds

  • Servings: 10
  • Time: Prep time: 10 minutes ¦ Total Time: 25 minutes (for cooling)
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Ingredients

1 tablespoon butter
4 – 5 teaspoons ground rosemary
1/4 teaspoon cayenne pepper (or more to taste)
1 1/4 cups (155 g) sprouted salted watermelon seeds, (Go Raw Brand)

Instructions

Preheat the oven to 350.

In a saucepan over low heat, melt the butter. Turn off the heat. Stir in the spices. Toss the watermelon seeds in the pan until evenly coated.

Spread coated seeds evenly on a parchment paper lined baking sheet pan.IMG_4085

Bake at 350 for 6 minutes, or until lightly browned.

Cool to room temperature before storing in glass under refrigeration.IMG_4090

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Fresh Pea Soup

Fresh pea soup is a lovely way to eat this vegetable.

Fresh Pea Soup

  • Servings: 6
  • Time: Prep time: 10 minutes Total Time: 20 mintues
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Ingredients

14 oz. peeled, chopped yellow onion
3 T Butter
2 pounds shelled fresh or frozen green peas
6 C chicken bone broth
¼ tsp. ground white pepper
Crème fraiche
mineral salt, to taste

Instructions

  1. Sauté the onion in butter for 5 minutes.
  2. Add broth and peas. Bring to a boil.
  3. Cook for 15 minutes.
  4. Puree soup with handheld (stick style) blender.
  5. Season to taste.
  6. Serve hot. Garnish with crème fraiche.

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Citrus-y Spiced Squash Salad

Squash Salad with Steak

Squash salad is part of a tasty and attractive plate!
Plate-mates: grilled lamb, mashed turnips,
Waldorf salad (apple), and boiled buttered peas.

Better than potato salad, this makes an excellent weekday lunch, and is great at a picnic or potluck.  Make it when fresh grapes are in season. This squash salad was a favorite at my May 19, 2015 lecture about oxalates and health.  I made enough for leftovers, but there weren’t any!  Several attendees requested the recipe, so here it is!

Citrus-y Spiced Squash Salad

  • Servings: 8-10
  • Time: 1.5 hours (make a day early)
  • Difficulty: Not for beginners, requires peeling squash and boiling
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Ingredients

one 3 – 3½ lb. winter squash seeded, peeled, and diced in ¾” – 1” chunks
1 C red seedless grapes, sliced in half, or ¼ C chopped Raisins or cranberries
½ med. Shallot, finely diced or ¼ C chopped chives or one whole scallion (opt.)
½ C chopped Cilantro
1 Scallion, green part only, chopped
1 med. organic Red Pepper, cut into short strips (¼”x1”) (optional) (or use organic roasted red pepper)

Dressing:
¼ C (or more) olive oil (part may be fractionated coconut oil, if desired)
¼ C Lime Juice (6 limes)
2 T Maple Syrup or 3 T Dextrose or 1½ T organic Sugar (this is one of the rare times I use sweetener)
½ tsp. Mineral salt
¼ tsp. each: ground Coriander and Cardamom
1/8 tsp. Cayenne Pepper (for a not-spicy version, use ¼ – ½ tsp. white pepper instead)

Instructions

  1. You may either boil (5-7 minutes in salted water) or roast the squash. The squash should be soft but not mushy. To keep the squash cubes more intact, chill the cooked squash before adding the other ingredients. For a multi-colored look, use both acorn squash and butternut (cooked separately).
  2. Mix the dressing ingredients together, then add the dressing and remaining ingredients to the squash. Gently toss to coat evenly.
  3. Chill 1 hour. May be served chilled or at room temperature.
  4. Garnish with additional cilantro leaves or red pepper strips or grape halves.

Lift finished squash from boiling water with long-handled skimmer.

Lift finished squash from boiling water with long-handled skimmer.

Final Step. Gently combine ingredients.

Final Step. Gently combine ingredients.

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Oatmeal Porridge

29131481_sSoaked / Lightly Fermented is the best way to prepare grains.

For digestibility, assimilation and nutritional benefit, grains (including breakfast porridge) should be soaked overnight or longer. With this method, the oats are set up to soak in acidified water for 8 – 24 hours. The setup is quick and easy to do after dinner or before bed.

Avoid over-reliance on starches and grains such as rice, corn, and oats. Eggs, fish, kefir, soups, cooked winter squash, and left-overs are more nutritious alternatives.

Oatmeal Porridge

  • Servings: 3
  • Time: set-up 8+hours ahead
  • Difficulty: Super Easy
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  1. Combine in a thermos, small sauce pan, or covered bowl:

1 C organic rolled or cracked oats

1 C warm mineral water or filtered water

2 T whey (liquid drained from yogurt)
or 1 T lemon juice or rice vinegar

  1. Allow to sit at room temperature for 8 – 24 hours.
  2. 15 minutes before serving, boil:

1 C mineral water or filtered water combined with
½ tsp. mineral salt such as Real Salt® or Himalayan Pink Salt dissolved in it.

  1. Combine the soaked oats and the boiling salted water, let sit for 5 – 10 minutes.
    Or, if you like you oats very squishy, heat and simmer for 3 minutes. Allow to sit for 5 minutes.
  2. Serve with butter and cream or half-n-half.
  3. Additional toppings: stir in sprouted flax seeds, or sprinkle top with coconut flakes or sprouted pumpkin seeds.

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Standing on Steady Ground: Resisting New Ideas

"Galileo moon phases" by Galileoyh Most people will find certainty and safety by subscribing to widely held ideas, regardless of the “truth” of those ideas.  Likewise, institutions and the people that are governed by them resist new explanations for phenomena. A classic example of this is found in the dawn of two radical ideas that 1) the earth moves around in space, and 2) the earth revolves around the sun. [Read more…]

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Letting Patients Down

No one goes through medical training so they can disappoint people with lousy outcomes and grievous errors in performing dangerous procedures. Yet, this is happening as a regular course of business in American Medicine. In my post, The Cost of Too Much Spinach, we have a case in point.  A young woman suffers from a painful aliment, kidney stones. When she turned to medicine for relief, she was granted a series of tests and surgery that were likely injurious. None of these procedures offered any benefit, not even an accurate diagnosis. Patients like tests, as they believe that a test offers them a definite understanding of their condition. This case shows that tests don’t always perform up to our expectations. Our reliance on technology and invasive procedures illustrate some serious failures in how American medicine is practiced.

In hindsight, we know that this young woman’s problem was kidney and urethral stones. She had terrible pain in her rib cage on both sides of her body. The local university medical clinic found a 110-degree fever and kidney infection. They performed many tests and also removed her healthy appendix. As Scott Miners wrote in the article I discussed in my previous blog post, the young woman “was very frustrated and still in pain when the clinic staff released her.”

Still in pain, she traveled across the border to Mexico where a naturopathic doctor performed an ultrasound test that found two kidney stones working their way out of her urinary tract. The naturopath’s herbal treatment may have assisted the stones passing and provided relief for the patient.

Many questions are raised by this case: Why did the doctors do so many expensive tests and surgery, yet not find the real problem? Are doctors unaware of kidney stones? Do they assume that only old men get kidney stones? Are they aware that kidney stones are becoming increasingly common in females and in children? Are they aware that extreme diets with very high oxalate foods can trigger kidney stones (not to mention other health conditions)? Will they ever consider a person’s diet when they’re trying to determine what’s wrong with their patient?

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The Cost of Too Much Spinach

In the July-August issue of Well Being Journal, Scott Miners1 shared the story of a teenager who went through a series of expensive diagnostic tests and unnecessary surgery. She had extreme pain and difficulty urinating. Four MRIs, 2 CT scans, and x-rays failed to detect her kidney-urethra stones. Without a correct diagnosis, they removed her healthy appendix. None of these medical procedures offered any relief.

This young woman suffered a great deal of pain, underwent dangerous surgery, and must have missed out on normal life activities due to kidney stones. Kidney stones are becoming more common, especially in women and the young. Yet, in this case, the best tests of modern medicine failed to detect them. Still, there were bills to be paid.

The costs of these tests vary a lot, in the table below I roughly estimate the expenses generated by this medical “wild goose chase”. Her kidney stone trouble may have generated nearly $50,000 in medical expenses, and they did her 36055303_sno good at all.

Sadly, she was never told, until after Scott read my article, that eating too much oxalate from spinach could be a risk factor for kidney stones. Scott writes: “… she said she had become a vegetarian four years earlier and had been eating massive amounts of spinach in those years, prior to the kidney stone formation.” Her likely purpose in eating spinach was to support her health, and not to make her sick and broke!

Medical Procedure Number Performed Cost Range  Total      Estimated Mean Cost
MRI $1,500 – $5,000 4 6,000 – 20,000 13,000
CT Scan $500 – $1,200 2 1,000 – 2,400 1,700
X-ray $300 – $600 1 300 – 600 450
Appendectomy Surgery median cost is $33,0002 1 33,000
TOTAL: $48,150

References:

  1. Miners, S. Kidney Stones and High-Oxalate Foods. Well Being Journal. 24:4, (2015).
  2. Hsia RY, Kothari AH, Srebotnjak T & Maselli J. Health care as a ‘market good’? appendicitis as a case study. Intern. Med. 172, 818–819 (2012).

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When Healthy Isn’t

Norton, S. "When Healthy Isn’t: The Risks of High Oxalate Foods." Well Being Journal. 24:4; pp. 16-24; (2015).

Norton, S. “When Healthy Isn’t: The Risks of High Oxalate Foods.”
Well Being Journal. 24:4; pp. 16-24; (2015).

Trying to “get healthy” can prompt you to order a spinach salad, get a juicer, and start pouring almond milk over your cereal. All these “healthy” actions can eventually add up to major health problems – ones you’d rather avoid. Problems like chronic pain, fatigue, and kidney stones can develop from too much “healthy food”.

You can protect yourself from current nutrition fads with science. Start by getting a copy of my article, “When Healthy Isn’t: The Risks of High Oxalate Foods” in the 2015 July-August issue of Well Being Journal. You’ll learn a lot, and you’ll want to share this eye-opening information with friends and family.

References

  1. Norton, S. When Healthy Isn’t: The Risks of High Oxalate Foods. Well Being Journal. 24:4, (2015).

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Catastrophic Complication of Weight-Loss Surgery: Kidney Failure

Figure 1 Nagaraju (2013). Large intraluminal translucent crystals of calcium oxalate, tubular epithelial degeneration (foamy cytoplasm, pyknosis, karyorrhexis, indistinct cell borders, dilated lumina), lymphocytic infiltration in the interstitium (H and E, ×400)

Figure 1 Nagaraju (2013). Large intraluminal translucent crystals of calcium oxalate, tubular epithelial degeneration (foamy cytoplasm, pyknosis, karyorrhexis, indistinct cell borders, dilated lumina), lymphocytic infiltration in the interstitium (H and E, ×400)

A case of kidney failure after bariatric surgery is stopped with low-oxalate diet.

Canadian nephrologists reported a case of life-threatening kidney damage caused by kidney deposits of oxalate crystals.1 The doctors performed a kidney biopsy on their patient, a 54-year old man, 20 months after duodenal switch weight-loss surgery. His blood creatinine levels had tripled over the previous nine months. The biopsy found oxalate crystals causing tubular damage and atrophy, fibrosis, and inflammation. They also noted hardening of the blood-filtering glomerular capillaries.

The patient was treated with a low-oxalate diet, calcium citrate (1,000 mg 3 times a day with meals), high water consumption, and the drug cholestyramine to help reduce oxalate absorption. This stabilized his blood creatinine levels and his urine oxalate dropped by a third from 99 to 63mg per day. Normal urine oxalate is under 40-45 mg/day. The authors’ want practicing clinicians to be aware of the increased risk of excessive absorption of oxalates from food following weight-loss surgery (“secondary enteric hyperoxaluria”) which can lead to kidney stones and life-threatening renal failure due to oxalate-induced kidney damage.

This case illustrates: 1) changes to gut function can alter oxalate absorption; 2) oxalates in foods can cause tissue damage; and 3) this process may be arrested by limiting oxalate absorption with a low-oxalate diet and supportive therapies.

Interestingly, this patient’s urine oxalate levels, although lower, remained elevated (63mg/day) despite effective diet therapy. Consistent with reports from cases of genetic oxalosis, this may indicate that the patient’s tissues are shedding existing oxalate deposits in the kidney and elsewhere in the body. The clearing of oxalate deposits may contribute to urinary oxalate, perhaps for years. It is likely that shrinking tissue oxalate deposits leave in their wake persistent renal scarring and tissue damage elsewhere.

Oxalate deposits can develop over time after either Roux-en-Y gastric bypass surgery (RYGB) or duodenal switch surgery. These surgeries can trigger an increase in the absorption of dietary oxalates (perhaps due to bile salts in the colon and fat malabsorption in the small intestine). This potential complication -the possibility of increased oxalate absorption leading to high urine oxalates and, eventually, kidney failure – is not typically discussed at the time of consent to surgery.2 Nor are these patients typically told that they can minimize the risk by modifying their diet to avoid oxalates in foods. Discharge and follow-up counseling and education should include instructions for the low-oxalate diet. The gastric banding procedure is not likely to cause this problem.2

Oxalate deposits in the body develop gradually and often without symptoms.3 Although rarely prescribed by clinicians, a low oxalate diet can help avert the risk of too much oxalate and may be especially important for people with intestinal and digestive problems, including, but not limited to weight-loss surgery.4 Other surgical procedures (intestinal resection, ileostomy, bladder diversion surgery) and GI conditions such as irritable bowel syndrome (IBS), celiac disease, Crohn’s disease, small intestinal bacterial overgrowth (SIBO), pancreatic insufficiency, or poor fat digestion (steatorrhea) can also contribute to excessive absorption of oxalates in the digestive tract.

The renal damage caused by oxalates may not be reversible so it is important to start the low oxalate diet as early as possible. Anyone who is increasing their water intake or taking calcium citrate to reduce absorption of oxalates needs to be aware that timing is important. Water with meals can increase oxalate absorption, so drink fluids between meals. Also, calcium citrate tablets need time to dissolve, so take them about 20 minutes before meals to maximize the oxalate sequestration effects.

Key Point: Dietary oxalates can cause kidney failure after bariatric surgery. The progression of the disease can be halted by the low-oxalate diet, if implemented correctly and early enough.

For my low-oxalate grocery shopping list click here.

References

  1. Nagaraju SP, Gupta A, McCormick B. Oxalate nephropathy: An important cause of renal failure after bariatric surgery. Indian J Nephrol. 2013;23(4):316-318. doi:10.4103/0971-4065.114493.
  2. SenthilKumaran S, David SS, Menezes RG, Thirumalaikolundusubramanian P. Concern, counseling and consent for bariatric surgery. Indian J Nephrol. 2014;24(4):263-264. doi:10.4103/0971-4065.133045.
  3. Marengo S, Zeise B, Wilson C, MacLennan G, Romani AP. The trigger-maintenance model of persistent mild to moderate hyperoxaluria induces oxalate accumulation in non-renal tissues. Urolithiasis. 2013;41(6):455-466. doi:10.1007/s00240-013-0584-5.
  4. Lieske JC, Tremaine WJ, De Simone C, et al. Diet, but not oral probiotics, effectively reduces urinary oxalate excretion and calcium-oxalate supersaturation. Kidney Int. 2010;78(11):1178-1185. doi:10.1038/ki.2010.310.

Further Reading about Bariatric Surgery and Oxalates

  1. Agrawal V, Liu XJ, Campfield T, Romanelli J, Enrique Silva J, Braden GL. Calcium oxalate supersaturation increases early after Roux-en-Y gastric bypass. Surg Obes Relat Dis Off J Am Soc Bariatr Surg. 2014;10(1):88-94. doi:10.1016/j.soard.2013.03.014.
  2. Ahmed MH, Byrne CD. Bariatric surgery and renal function: a precarious balance between benefit and harm. Nephrol Dial Transplant. 2010;25(10):3142-3147. doi:10.1093/ndt/gfq347.
  3. Asplin JR. Hyperoxaluria and Bariatric Surgery. In: AIP Conference Proceedings. Vol 900. AIP Publishing; 2007:82-87. doi:10.1063/1.2723563.
  4. Froeder L, Arasaki CH, Malheiros CA, Baxmann AC, Heilberg IP. Response to Dietary Oxalate after Bariatric Surgery. Clin J Am Soc Nephrol CJASN. 2012;7(12):2033-2040. doi:10.2215/CJN.02560312.
  5. Kumar R, Lieske JC, Collazo-Clavell ML, et al. Fat Malabsorption and Increased Intestinal Oxalate Absorption are Common after Rouxen-Y Gastric Bypass Surgery. Surgery. 2011;149(5):654-661. doi:10.1016/j.surg.2010.11.015.
  6. Lieske JC, Mehta RA, Milliner DS, Rule AD, Bergstralh EJ, Sarr MG. Kidney stones are common after bariatric surgery. Kidney Int. October 2014. doi:10.1038/ki.2014.352.
  7. Nasr SH, D’Agati VD, Said SM, et al. Oxalate Nephropathy Complicating Roux-en-Y Gastric Bypass: An Underrecognized Cause of Irreversible Renal Failure. Clin J Am Soc Nephrol CJASN. 2008;3(6):1676-1683. doi:10.2215/CJN.02940608.
  8. Patel BN, Passman CM, Fernandez A, et al. Prevalence of Hyperoxaluria After Bariatric Surgery. J Urol. 2009;181(1):161-166. doi:10.1016/j.juro.2008.09.028.
  9. Ritz E. Bariatric surgery and the kidney – Much benefit, but also potential harm. Clin Kidney J Clin Kidney J. 2013;6(4):368-372.
  10. Whitson JM, Stackhouse GB, Stoller ML. Hyperoxaluria after modern bariatric surgery: case series and literature review. Int Urol Nephrol. 2010;42(2):369-374. doi:10.1007/s11255-009-9602-5.

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