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FAmQs part 3

Round three! I arrived at somewhat longer answers this time… but please enjoy, and keep the questions coming!

Do you think “Bulletproof” coffee is healthy? The short answer is no. Grass-fed butter is lovely and a good source of healthy fat. Coffee can be ok for some people who don’t become jittery from it and don’t have stomach acid issues, and several cups a day may help some people with predispositions to diabetes, Alzheimer’s, and colon cancer, but for many people it causes health problems. Coffee suppresses the appetite quite dramatically at the same time that it increases glucose consumption, making one hungrier and prone to blood sugar dips and spikes, so this might cause more overeating, even more likely if it isn’t consumed with healthy carbohydrates. It can also worsen reflux and stomach acid problems. The idea that you need to buy their special coffee (to avoid mycotoxins- most beans are wet processed now anyway to wash those off, and all coffee is fermented), their special MCT oil (more expensive than others available), and use two tablespoons of butter is excessive and ridiculous. Yes, Tibetans and others drink yak butter tea, but because they need the extra calories in their extreme environment, and the combination works for them. Most people don’t need a giant dose of oil first thing in the morning consumed with no other food… for me that sounds like a colon cleanse. I can’t endorse this latest fad, but if you enjoy the taste, and are healthy otherwise, see what you think!

Speaking of cleanses…

What do you think of the Kambo (frog) cleanse? First, check out my cleanse post here. There is a fascination with ‘cleansing’ in pop-health culture. The body does an impressive job cleaning itself at every moment, and it needs very little assistance- unless there is an overwhelming amount of unhealthy items ingested (see my answer below to someone’s response to the Dr. Dean Ornish article). The Kambo poison is given through fresh burns on the skin and quickly acts as an extremely violent and painful purgative, after which practitioners say they feel amazing and are healed of various ailments. There is evidence that the chemicals in the frog toxin may be helpful against cancers and may be effective antibiotics, at least in laboratory studies. More good things found from the rainforest, I would imagine. The history of this particular practice involves a shaman taking ayahuasca and learning this toxin would improve his hunters’ skills, and it seemed to work in that setting. For westerners, it doesn’t seem to have lasting effects, but may have a temporary euphoric effect (from the relief after purgation?). Physically, I haven’t seen any believable documentation that it heals or cleanses anything in particular, but it doesn’t appear to be harmful long-term from the few case reports out there. I would suggest seriously thinking about why you feel you need a ‘cleanse’ in the first place. Are you eating less than healthily or not sleeping, are you taking in more poisons (cigarettes, alcohol, processed foods, pesticides, plastics, air pollution etc) than you think is healthy, and are you failing to exercise your mind, body, or spiritual side? Personally I’d suggest a more targeted approach to change the long-term trajectory of your health in a way that you can stick to, rather than ceremonies involving violent vomiting, uncontrollable diarrhea and loss of consciousness or blindness- but that might just be me… Honestly though, from what I’ve seen of liver failure from plant and animal toxins as well as post-hallucinogenic brain effects, I’d stay clear of most mind-altering toxic substances that haven’t been adequately proved to be safe. That doesn’t mean you shouldn’t do it, but please do your research and know what you’re getting into, and the credentials of the person selling it.

Should I eat the Dr Dean Ornish diet from the NYT article? For people who have lived a long time with high-poor-fat and high-refined-carbohydrate diets, at high risk for cardiovascular disease and cancer, yes, Dr Ornish’s program will put you on a healthy path faster than any other diet. His program of no animal products, no sugar, and almost no fat, includes exercise and meditation and counseling, does have the ability to decrease clogged arteries, reduce inflammation, and start to reverse obesity and diabetes. It sounds severe, but in Eastern medicine, his patients are at the end of a disease process that requires drastic measures to add years to their lives, lives which would otherwise likely involve heart surgery and/or large amounts of medications to keep them going. His program has a few holes (not insisting on whole grains, not encouraging sustainable farming, and not allowing a more satisfying proportion of healthy animal or vegetable fats), but these holes may allow his patients to be more compliant and still have good results. It is good for its intended purpose. I think he makes a mistake to generalize. I also agree with a couple of the rebuttals online- his insistence that highly refined vegetable oils are a healthier alternative to animal products may not be correct (any more than margarine was a good idea back in the day). I entirely disagree that paleo and atkins high protein diets are a healthier alternative: this has been proven to be incorrect and even harmful. High protein diets increase the risk for cardiovascular disease in middle-aged women, while whole grains (vilified by paleo-pseudo-science) are anti-cancer and anti-diabetes in studies across the board. And of course, the widespread adaptation of this diet would be (as American agriculture currently stands) terrible for the environment. An anti-inflammatory, earth-friendly diet seems a better long-term plan for the vast majority of moderately healthy people: mostly plants from sustainable sources, small amounts of anti-inflammatory pastured animal products, whole grains and almost no processed foods or sugar. Add meditation, stress management, exercise, and good sleep habits and you’ve done your best to change your genes, and prevent heart disease, cancer, and all other ‘lifestyle’ diseases.

How do I choose what to worry about with all the information coming at me? A few patients have expressed frustration about the overabundance of information they find when they try to decide what to eat, what to avoid, and what applies to them individually. They tell me it’s hard to maintain sanity when trying to intelligently piece together everything (with often contradictory information!) to make sure they are doing everything correctly for their health. I agree. The most important thing first is compassion for yourself. This means serious knowledge of who you are, what your capacity is for understanding and change and perseverance, and what your expectations are for your life as a whole. This involves comfort with uncertainty. Everyone moves towards old age and death, without fail, and none of us knows when or under what circumstances anything will happen. Science itself and information changes daily- there is no way any of us can be sure any one piece of information will stay true and ‘correct’ even if it seems very certain now. Once you are at peace with these things, your can prioritize more easily. I have noticed that for most of us, these often end up being: 1. Caring for our bodies and minds as we would a child or dear friend (without judgment or rigidity) so that we may be as healthy and comfortable for as long as possible, then 2. Picking our ‘poisons’ that may not be perfectly healthy according to whatever source seems credible at the time, but which enrich our lives to the point that the enrichment outweighs the seeming ‘correctness’ of the choice. To do this, we need to pick trustworthy (to us) sources of information, and notice nonjudgmentally our preferences for things that are deemed ‘wrong’ by one or more of those sources (sugar, meat, alcohol, grains, dairy, pesticides, plastic, electronics, petroleum… etc etc etc). One might decide that it’s ok to eat sugar on weekends but not during the week if one gets exercise daily. One might decide to have a glass of wine per night and stop something else on the list of ‘unhealthy’ items. One might decide to take up a form of exercise that is intense and worry less about food choices. One might take up meditation and gardening and become vegan. Or one might try to do everything ‘right’ they learn about. And of course, all of us might change our minds when new information seems to override past information.

All of these are good choices for individuals. Each person must remember that I (and anyone else with information for you) can only suggest what I know and think might help. But YOU must decide if what any of us says is true for you. Above all, stressful rumination on what is ‘good’ and what is ‘bad’ is likely more damaging than most poor choices, and things like sleep, meditation, and exercise are above and beyond the most helpful in maintaining mental and physical health our entire lives. Choose enthusiastically and enjoy your choices! Then be mindful about how your choices make you feel, short AND long-term— get to the root of reasons why you don’t always make choices that make you feel well— then get rid of the root. (And ask for help if it’s difficult!)


Colorado hikes!

Colorado hikes!

FAmQs part deux

So many more great questions from readers- keep them coming!

Can drinking too much alkaline water give you kidney stones? Drinking too much water can be harmful anyway, but too much extra-alkalinized water can possibly dilute stomach acid slightly, and if someone is ‘too alkaline’ to begin with then it potentially can cause bone degeneration and a host of other crazy serious problems. But basically it’s a marketing idea. There’s no evidence anywhere that alkaline water does anything helpful at all. There is of course evidence that a diet high in vegetables (which is part of the hyped ‘alkaline diet’) does reduce risk of most types of cancer. Also, on all the ‘alkaline diet’ websites, lemon is listed as ‘alkalinizing.’ So you can make your own alkaline water if you feel it’s necessary by squeezing a bit of lemon in your regular old filtered tap water!
* water tip: sip hot water when it’s chilly out or if you’re not feeling well- it will keep you warm and be less likely to cause nausea
* water tip 2: hydrate away from food and exercise- let your stomach acids work undiluted for a bit during and after eating, and let your body sweat and focus on catabolism (unless you’re sweating ferociously from hot yoga or a very long workout, your body should be hydrated enough to get through over an hour of activity without drinking).

Speaking of drinking… how much alcohol is healthy? Ah this one is a bit tricky. So, alcohol is a cellular toxin, and the most recent medical advice is ‘no amount is safe’ largely because people who drink any have a higher incidence of cancers. The studies, though, don’t separate out people who eat different types of diets, meditate or not, take supplements or not, exercise or not… you see where I’m going. It’s true, it’s a poison, more clearly so than something like carbohydrates, which are only a poison if eaten in excess and worse if highly refined. That said, small amounts might be helpful in keeping the liver ‘revved up’ for detoxification, and for digestion in certain cases. Red wine may be helpful for preventing heart disease, so if that’s more likely for you history-wise than cancer, maybe it’s a positive. Also, of course a case can be made for enjoyment and life enrichment- I know even a sip of certain wines have given me near-religious experiences! For me it is a case of ‘picking your poison.’ If you really enjoy a small amount of alcohol, having some occasionally may be equivalent to eating a poor diet, is certainly not as terrible as smoking cigarettes, and may be similar to staying in a situation in life that causes unhappiness. If you smoke, are unhappy, and eat poorly, drinking alcohol is definitely going to be worse for you than for someone who has a healthier lifestyle. In any case, be informed, and ask your health care provider if the amount you drink seems risky and ask what might be a better level for you. I’d say one glass a night might be ok for most people who are interested, all else being healthy!
*p.s. do NOT drink while taking Tylenol/acetaminophen/paracetamol, or with high doses of vitamin A, or some medications. And don’t ever drive when drinking. Be careful of others, and your liver, please.

What probiotics are best? The simple answer is we aren’t sure- there are a few medical-grade ones (which are also well-regulated, as opposed to most of the drug store versions– even expensive ones have been proven to not contain the strains or as many as they claim) which do work for specific conditions and diseases, but overall there’s not a huge amount of evidence. The plethora of gut flora we all have is different for each of us, and can change drastically in as little as 24 hours if we change our diet. There are also ~4-5 POUNDS of bacteria in our guts… so taking a teeny pill may not be super effective even if it was a fantastically personally helpful strain. I suggest eating lots of fruits and vegetables, raw and cooked, lots of whole grains, and healthy fat and protein sources, and as many fermented foods as you enjoy. Yogurt, sauerkraut, kimchi, pickles, miso, tempeh, and kefir are all time-tested fermented foods that taste great. (I’d include natto, but I personally can’t stand it!) I also believe in the placebo effect though, and most probiotic pills don’t seem to be harmful (and may help!), so I’d check what brands you have available and try a couple, see how you respond, and if it seems to work for what you were trying it for, go ahead. But making your own yogurt or (buying fresh local) and eating more veg/whole grains with adequate fiber is cheaper and likely more effective long-term… think of it more as growing a garden and building up soil (= your base of healthy bacteria that help digest your food and make your vitamins!) over time rather than making occasional war-like forays into a jungle with pills or big amounts of one specific food.

What is the best anti-cancer diet? First it depends what type of cancer we’re discussing. Vegetarians and vegans who eat whole grains seem to have the least incidence of gastrointestinal cancers, low-fat vegan with a bit of fish seems to help prevent prostate cancer, and large amounts of fresh vegetables seem to do well for preventing most cancers in general. I do think there are helpful nutrients in animal products, and I said earlier I’m not convinced that all the vegetable oils that are popular (especially in processed foods) are better (and they may be worse) than animal fats. Secondly, while ‘anti-cancer’ is important, so is ‘anti-diabetes’ and ‘anti-arthritis’ and ‘anti-alzheimers’ and ‘anti-vascular disease’ etc. Let’s turn this around positively: Eating a diet of whole mostly plant foods is proven to improve health and prevent disease. Add avoiding tobacco, alcohol, and oxidized oils and carbohydrates (= few processed foods, few fried, roasted, or baked foods). Add some anti-angiogenic teas (jasmine white, earl grey, sencha) and anti-inflammatory spices like turmeric (mixed with others like black pepper is best). Make certain you eat the most colorful version of the fruit or veg you can find (purple carrots, black raspberries, swiss chard), and don’t overdo anything. And: exercise, sleep, meditate, and find a job you love and spend time with loved ones… and ask me if you have personal cancer-diet questions for chemo or recovery!

How much protein do I need in a day? The number technically depends on muscle mass and metabolism, but also on what your protein sources are. The basic recommendations are 45g for women, 50-55g if pregnant or breastfeeding, and 55g for men. Having been vegetarian for 17 years and failing to monitor my protein intake adequately, I can personally attest to the symptoms of protein deficiency as well as the weight loss and easy muscle building that happened when I returned to eating some animal products. That said, if you’re careful, it is not difficult to get adequate protein from a variety of sources. Nuts and seeds as well as whole grains and even vegetables are often overlooked, but the added healthy fats, vitamins and minerals, and fiber from these vegetable protein sources should be included in a meat-eater’s diet as well. As a bonus, they allow for less animal protein to be consumed (better for the environment as well!). I’d suggest that if you eat from a variety of protein sources then 5-10g less than recommended is probably just fine, and if you are exercising more than moderately or have been ill, 5-10g more is likely helpful to help rebuild what was broken down.

What sweeteners are safe? This one was tricky- anything can be a poison or a benefit depending on dose. So here’s a rundown:  1. Artificial sweeteners (‘diet’ drinks and foods) do not help weight loss or diabetes prevention  1.5. Artificial sweeteners may convince your body sugar is coming in, then when there aren’t real calories to deal with, it may overshoot how much insulin is released, making your blood sugar lower, which makes you hungrier so you eat more calories overall anyway  2. Agave is not good for you– it’s highly processed and has more fructose than high-fructose corn syrup, and because of that it is likely even worse for your liver  3. Stevia may actually be anti-diabetic and anti-inflammatory (who knew? but I still can’t stand the taste!)  4. Anything that delivers a fast hit of sugar to your system is still ‘sugar’ even if it has other nice properties– like maple syrup or honey– use sparingly  5. Highly processed sugars are likely worse (faster absorption from straight sugar and liquid sugar means harder impact on the insulin system and liver), so be extra careful with hfcs, white sugar, corn syrup, and brown rice syrup, since they are included in many many processed foods (including health-food bars and spaghetti sauces!)  6. Beet sugar is becoming more popular, it may not be labeled, and it’s mostly GMO, if you’re worried about that.

What is oil pulling? Only my favorite health improver! It cured my 25 years of gingivitis and sensitive weak gums in 6 months. No joke- my dentist was so completely shocked she tells her patients to do it now! I wrote a post about it a while ago, but put simply—dental health improves whole body health, and oil pulling is a way to vastly improve your dental health but it needs to be part of a daily routine to be of real benefit. Brush 2-3 times per day with a sonic or regular extra-soft toothbrush with flossing bristles. Before sleep, floss attentively, then brush. In the morning, first thing before you eat, scrape your tongue, brush, use a gum stimulator if you tend to have plaque or weak gums, then take a teaspoon of sesame oil (winter) or coconut oil (summer) and hold it in your mouth, swishing, for 5-20 minutes. It will mix with your saliva, so when you need to, spit into a (lined, obviously) trash can (the oil, especially coconut, can clog cold water pipes even in a toilet over time). For extra credit, there are reports it helps with allergies, reflux, and skin problems as well! It’s not proven, but it can’t hurt to try it for a few weeks and see if your teeth aren’t also whiter and your gums healthier!

and go for hikes up mountains!  :)

and go for hikes up mountains! :)

Frequently Asked (Medical) Questions

For my inquisitive friends and former patients: Answers to the most common questions I’ve had recently, for your entertainment and conversation. Please email if you have counterpoints, questions, or comments!

Should I take Vitamin D? Depends- Deficiency symptoms may also be due to hormonal changes, digestive difficulty, as well as not enough pineal gland stimulation by sunlight which will throw off the circadian rhythm and confuse other bodily processes. It seems not harmful to take up to 2000 daily, but, especially since it’s a hormone, I’d pay attention to finding out why someone is deficient in the first place, getting natural light at appropriate times, and fixing any digestive difficulty, as well as intaking adequate nutrition.
* and if you do take it as a supplement, remember it is fat-soluble (like A, E, and K), so you need to take it along with food with fat in it, or your body won’t absorb it!

Should I try the raw food diet? While not inherently harmful, it’s not a long-term healthy plan for most people. Keep in mind that we humans grew large brains because we started cooking our food (and getting more nutrients out of it, leaving our bodies’ digestion energy to be used in other ways), so the argument that raw is healthier is completely wrong. Nutrition content of different vegetables and foods depends on each food (check out the book “eat wild” if you’re intrigued), and different people have different digestive strengths. Keep in mind also that your body has to ‘cook’ everything you put in it to be able to use the nutrition from it, so eating only raw is a huge energy requirement for your body as well. Many people feel amazing when they start a raw food diet, likely because they’ve stopped eating processed food and things that may not be very healthy for them. But the worst diet-induced digestive and immune dysfunctions I’ve ever seen have actually been in raw-foodists that have been eating that way for 3-7+ years. It seems that, like everything else, the best idea is to eat a variety- in this case a variety of raw and cooked food, depending on your personal digestive strength and nutrition needs. For most people, I suggest between 10-40% raw (most of it vegetables). The higher percentage is if you are trying to lose weight, have a particular health concern, or are doing it for religious/meditative reasons. The lower percentage is for those with weak digestion who are building a better gut flora profile which may need to be done gently.

Should I eat more vegetable oils and spreads instead of animal fats? No, there is not enough evidence in my opinion that ‘vegetable oils’ are better for us (except olive oil). The issue may have more to do with whether the fat is oxidized or not. To decrease your free-radical intake (to help decrease artery damage), cook with liquids more often (add water to steam-stirfry, braise, poach, and boil when practical and tasty), use oils with lower smoke points like olive oil for water-cooking and raw preparation, and use oils with higher smoke points (pasture-grazed ghee or fair trade/organic coconut oil) when you absolutely must cook at a higher temperature (roasting and pan frying should be rare).

Should I eat fewer animal products if I am trying to be healthy, lose weight, or prevent heart disease? Not unless you consume an inordinate amount (= two or more meals daily). Eating animal products isn’t inherently harmful. Instead, pay attention to the quality of what you eat. Consume only animal fats from animals that have been only pastured (happily and sustainably raised chickens, pigs, sheep, and goats, or wild sustainably hunted animals if you’re into that), and especially only grass fed cow products like beef and dairy and butter. Several studies now show the improved nutrition profiles of these and their anti-inflammatory properties, just like many studies show the harmful effects of corn fed and feedlot-raised cow products. Some fish consumption seems to be beneficial as well, but not shrimp, and others only from sustainably managed fisheries, and not from farms (especially farmed salmon which can be as unhealthy as corn-fed beef; the exception may be oyster farms). Mostly, decrease your risk of all of those things and improve your heath by meditation, exercise, and moderate eating.
* the caveat here is cured (processed with salt, smoke, etc) meat products (such as hot dogs, sausages, bacon, ham, kebab meat, etc)– these have been proven to cause the most cancer of any food and cause earlier death in those who eat them most days, so eat these sparingly if at all!

Should I eat more soy or whey products to get adequate protein? First of all, most people who eat balanced diets get more protein than is absolutely necessary. But if you’re vegetarian or really excited about exercise, you may need to be more conscious of how much you need and what combinations will get you the amino acids your body can’t make on its own. Old-recipe soy products are likely very healthy for you, like non-gmo organic tempeh, tofu, miso, and soy sauce. Newer highly processed formulations (like those ‘fake meat’ concoctions) are where the problems likely lie. Heating protein isolates to high temperatures for use in protein powders or processed food likely changes the structure of the proteins and may be the cause of some of the hormonal, oxidative, and digestive disturbances seen in studies of people who eat these types of foods. I suggest if you can’t buy the ingredients listed on the package of protein you’re looking at in the store it came from, leave it alone and eat something you can identify.

What diet is best for general health and which is best for weight loss? Easy answer. None of the popular diets are better than any other except this one: whole foods, plant-heavy (80% is a good start), no heavily processed foods at all, no sugary or artificially sweetened beverages, only whole-ground flours but otherwise eat entire whole grains that are high in fiber, and little to no alcohol. Exercise an hour every day or more, and make sure do something that makes you sweat seriously at least 3 times per week. Relatively simple, but not quick or easy if you’ve been doing the opposite for a long time—but this is the only way that works.
* p.s. high-protein diets have been harmful for females in some studies, leading to higher cardiovascular risk, and don’t have a better weight-loss advantage over moderate whole food diets… and also– eating whole high fiber grains decreases the risk of diabetes and intestinal cancer across the board!

Should I eat organic? I think at this time it’s a good option when your choices are only ‘regular’ vs ‘organic.’ If you have more choice, there are better options- buying from local farms and buying in-season may have more immediate environmental impact, with the added benefit that if your local farmer is nearly organic or sustainable, you can encourage them to keep going in that direction. Buying from farmers markets improves the local economy and also puts more money in the farmers’ pockets- and if they have more flexibility financially they may be able to invest in more sustainable practices and get out of the traditional hamster wheel of gmo and big-ag suppliers of petroleum fertilizers and pesticides. Permaculture is I think the only way to go at this point for the long term, but my advice is to do what you can when you can. Spend the extra to eat organic thin-skinned produce (strawberries, stone fruit, potatoes, apples, grapes, spinach, tomatoes) as much as possible, and invest in quality animal products.

What type of bottled water, juices, and sports drinks are best? None. Get a reusable bottle and a water filter you like the taste of and stick to that. Juices are highly processed, generally not fresh, and high in quickly-absorbed sugar you don’t need- eat a piece of whole fruit. Sports drinks are a huge marketing ploy and have artificial flavors and sweeteners that your body doesn’t need at all. Unless you’re running a marathon or doing something equally strenuous so you desperately need the electrolytes, don’t bother– ditch the plastic bottles, save oodles of money, stay hydrated with water when you’re thirsty, and drink tea and coffee you make yourself out of a reusable container.

How much sleep do I need? Depends on you, and depends when you sleep, but likely somewhere between 7.5-8.5 hours. If you go to sleep nightly at 10pm and allow yourself to sleep as long as necessary for a week or two, you’ll eventually catch up and know when you feel best. The body rests in approximately 90 minute cycles, so whatever iteration leaves you feeling most energetic is your best bet– some people feel genuinely great with 6 hours, some need 9. The most important thing here is keeping your circadian rhythm steady- get enough UV light in the mornings, go to bed at the same time nightly, eat regularly, and get exercise daily. This helps your body set its clock and thus its hormonal cycles. If your daily cycle is off, so will your monthly, seasonal, and yearly cycles, which will take health and years off your life. Sleeping well is the most comprehensive way to keep your brain, body, and emotional health in good shape :)


and of course... view more castles :)

and of course… view more castles :)


Hi, all! I know it’s been forever, so thanks, friends, for coming with me on my travels and giving me such great feedback and support! I am currently in Virginia, and heading back to Europe in two weeks, and will be back in the states again in May. I’ll hopefully be in the midwest in June or July, but that’s as far as I have set up so far.

I’ll be stopping in Santa Barbara in either late May or early June depending on a few variables, and may be able to check in with a few patients in person, but we’ll have to see. Please send an email if you’re interested so I can plan accordingly!

The book is coming along, but slowly, and I’d love any quotes you’d be willing to share about your experiences with my version of whole-person medicine, positive or negative! The book is focused on communication, so any strengths or weaknesses you’ve experienced with me or any other doctor would be great to add in, anonymously or with your initials or names, as you prefer.

Also, if any of you know a web designer and website expert that could help me design a new site on a new server that would be fabulous. I’d like to keep all my current writing and not have to move it all myself like last time! Thanks!

Happy trails to all of you, have a fabulous 2015!IMG_3043


Yesterday, while catching up on medical concerns with a patient before we started her Osteopathic session, I said “oh, yes, I tried that too” to convey understanding about what she was telling me regarding her experience with ADHD. She had been wondering whether to try a new treatment, and she stopped short. She was so surprised, and asked me, “Wait, you have this?” And I said, well, not the hyperactivity symptoms, but yes, I’ve been dealing with it since I was a teenager. It seemed to help her trust what I had to say about effective treatments and medication options, so I thought maybe it would be helpful to write about too.

Typical of many girls with mild attention-deficit symptoms, my main issues growing up were becoming bored and fidgety or even combative after only a few minutes of something I wasn’t extremely interested in, forgetting to do things like homework while doing adequately in school (so as to not raise any red flags learning-wise), getting in trouble over and over in class for falling out of my chair or daydreaming or talking, having major depressive symptoms with serious irritability and quickly becoming frustrated, and being able to ‘hyper-focus’ for hours on end on something I was truly interested in (in my case it was usually books or video games).

It wasn’t until around age 12 that I realized one day playing my game-boy, that my body was hurting all over laying cramped on the couch playing, and I didn’t want to eat dinner because I’d just ‘won’ and the game had automatically started over at a harder level… I was willing to be in pain and not sleep or eat in order to keep playing. I felt so angry about everything (mostly at my mother insisting that I pause the game- which turned off automatically after 10 minutes on pause so I rushed through eating), especially at any attempt to get my attention- I was so intent that didn’t hear anyone unless they were touching my shoulder at which point I would jump and yell at them- that a lightbulb went off: I didn’t like myself like that. I decided to put the games above my tallest bookshelf and not play them again.

Somehow I got through college (with an unimpressive GPA from taking so many classes and not being able to complete the entire curriculum for any one of them), but afterwards I was lost. I didn’t know how to do anything but be in school, even at the sliding-through level I generally took, and I was dealing with emotional trauma I hadn’t had help processing yet, so my mother paid for me to go to therapy while I looked into going to grad school. I took Effexor (venlafaxine), which is a combination SNRI (serotonin and norepinephrine) receptor blocker. In those three months, my mother and I didn’t fight once. (A miracle, honestly, given our violent and frightening history.) I studied for the MCAT, albeit cursorily, by skimming the entire Kaplan book in 3 days, seated at my desk, without music or food as with my previous study habits. And then, at the end of the summer, the relationship I was in went through a rough patch, and I stopped my medication cold turkey. (NEVER do that, by the way. Withdrawals are absolutely horrific.) Fighting with my mother commenced shortly afterwards, and I was told to either pay rent or leave, so I left the next morning, and decided that I’d try to find ways to deal with my sensitivities and attention issues without medication if I could.

The next chapter of my life really began after a year of working in a restaurant, using alcohol to calm myself down in order to be social, and playing video games until 3am most nights, when I somehow was accepted into medical school. I went through two video games there, one each year I lived in Kansas City, until realizing after one 8 hour bout wherein I ate an entire box of Better Cheddar crackers and drank only 20oz of Mountain Dew that day, that again, this was not the way I wished to live. My ban on video games resumed. I finally learned to study, even though it was with enormous amounts of caffeine, and also tried a few other anti-depressants and stimulant medications, but every one either gave me untenable gastrointestinal side effects or caused such nausea and anorexia that I would stop after 2-3 days. Personally, with no medical evidence for this, I blame the withdrawal-induced traumatic brain pathway I gave myself, and assume my gut-brain connection just decided it had had enough of me messing with it.

Now, I never had the major issues or severe symptoms that some of my patients have experienced, but it was enough of a problem that when I was semi-officially diagnosed (I didn’t want it on my medical record, so my psychiatrist at the time just spoke with me about it at length), it was actually a relief to know I wasn’t simply ‘lazy’ or ‘lacking motivation’ as I’d been told when I was younger. As for the sometimes frightening hypersensitivity to sound and busy environments I had experienced since I was about 6 years old, my psychiatrist attributed those issues to the same group of symptoms, and gave me a ‘good’ reason to leave environments that were difficult for me to handle and to take time to myself when I was overwhelmed.

Fast forward through residency, where the stress of losing my mother, 100-hour work weeks, and the fear of causing harm to patients seemed stimulating enough to force me to learn what I needed to become a good physician… then to today, and my current way of living. I’ll share the things I’ve learned, many of them in the last 5 years, that help me accomplish necessary tasks, and allow me to be creative and passionate without letting me forget about responsibilities I’ve taken on. I don’t do every one of these perfectly, but these are definitely the most helpful non-medical ADHD symptom modifiers I’ve found.

* I meditate every day. As my ‘Insight Timer’ on my phone records, I’ve missed 3 days in the last 400. And I felt it when I did! Nothing has given me more insight or helped me more in my own life, and nothing has allowed more healing. I recommend developing a personal regular practice of some kind very highly, no matter what your experience level or belief system.
* I take on only as much as I truly can handle- Some days that isn’t much, and as an introvert, I need a lot of time to recharge between activities. If I don’t take the time I need, or if I stack my schedule too high, I get sick, depressed, frustrated, and am ineffective at work.
* I haven’t had a TV since I was 19, and only watch with my housemates when I truly have no responsibilities and can waste a few hours, and really enjoy what is available. Otherwise I keep a Netflix queue and only watch when I can truly take time off.
* I am not allowed to play video games, and if I try one that makes me think about it after I put it down, or if it causes me to miss something someone around me said, it’s over.
* I go to bed at 10pm and get up as early as I can- my favorite time is 5:55am. I need a lot of sleep to recharge, to allow my overstimulated brain to ‘file’ important things and get rid of things I don’t need, and to make sure I am well-rested and alert so when I need to focus during the day I am able to without medications or caffeine.
*  As much as possible, I eat whole foods without chemical additives and avoid refined sugars (including agave, hfcs, brown rice syrup, coconut sugar, and crystalline fructose… there are probably more…). Some people may benefit from avoiding flour also, and some may benefit from avoiding dairy. Personally I love home made sourdough bread and grass-fed whole milk for the omega 3s, but that’s my personal preference.
* I don’t try to multi-task anymore. It’s not possible anyway, and it’s not worth the frustration and disappointment when I fail.
* I write everything down in pen, keep an online office schedule also so I have to cross-reference and don’t forget something, and I make lots of hand-written lists, but re-write them when many things are crossed off or too many new things have been messily added. I do not use my phone calendar or reminders (I am on the internet too much anyway, and writing with my hand allows me to remember photographically much better than typing), and when I leave myself a voice note or need to write a note in my phone, I transfer it to a word document as soon as I can or put it in my written paper calendar, or I act on it right away.
* Most of all, I am as understanding and realistic as I can be about myself. I keep what matters to me in the forefront of my mind, and stop to reevaluate as needed. I am comfortable being wrong, and work daily on being flexible while sticking to what is important to me.

I hope that was a little helpful, and if nothing else, sometimes it helps to know that doctors are regular humans too. The people I look up to most are those that have had to work with something that was not easy and found ways on their journey to be even more bright, loving, and compassionate. In my case, I hope to use my experiences to help others if possible, and at the very least, to learn to be more peaceful and kind to myself.