Sunday, January 17, 2016

Fishing for Depression Patients

I knew last summer when I saw the headline that there had to be a new depression medication out. How? The news was "All Americans Should be Screened for Depression."(1) That's a good idea because, as you know, depression is a menace, affecting tens of millions and leaving many of its victims tired, overweight, prone to heart disease, impotent, blind, and--wait, I'm thinking of diabetes. It might make sense to screen everyone for diabetes. No, the reason for screening everyone for depression, I figured, was that there was a new drug someone was looking to peddle. Sure enough, the FDA approved a depression drug a few weeks earlier.(2)

Some doctors are already screening patients--like me--for depression during routine office visits. My invoice for being seen for a puncture wound included "brief behavioral assessment," which I didn't remember getting. When I called the office about it, they said they gave everyone that assessment through a questionnaire. I do remember filling out a large amount of paperwork.

Some depression drugs have been shown to be no more effective than a placebo and can have serious side effects. Further, it's one more thing for doctors and patients--many in an overburdened system--have to do. This particular drug may even kill you--there's a warning about suicidal thoughts and increased risk of death for certain patients, and weight gain and a sense of restlessness common among people in a study who took the drug. And all they got was a lousy reduction of symptoms. (3)

The article about recommending depression screening made no mention of the other trade-offs involved in adding another step to routine patient visits: more time filling out paperwork for patients, more prescriptions that may or may not do any good, and less time and money for everything else that doctors and patients already have on their plates.

Sources:

  1. "All Americans Should be Screened for Depression, Panel Recommends" by Andrew M. Seaman. Huffington Post, July 8, 2015.
  2. "FDA Approved New Drug, Rexulti, for Depression, Schizophrenia" by Robert Preidt. CBSNews.com. July 13, 2015.
  3. Ibid.

Tuesday, December 29, 2015

GI Distress and Moderation

It started with a round of healthy exercise back in 2012. I was riding my bike one minute and face-down on the sidewalk the next. My dentist predicted the two teeth that were knocked out of place would need a root canal someday, and early this year, one of them did. It took three rounds of antibiotics to clear the infection.

The antibiotics left my already-touchy stomach railing against anything fatty--in other words, my normal diet. A few months later, the stress from a cross-country move where a lot was up in the air for months (my job, the purchase of one house while selling another, getting ready to sell the house, researching where to move), plus taking and then giving up my mother's dog, made 2015 the most stressful year I've ever been through. My nearly hour-long commute and going at ramming speed at work added to the stress. Then I stepped on a nail the night before I was going to pack up my stuff and leave--and I'm bad at packing. I pack up what I think is everything, look around, and see more stuff to pack. Repeat several times--with an injured foot. (ETA: I conveniently lost the antibiotics for my punctured foot after a couple of doses.)

I tend to undereat when I'm stressed out. Therefore, my diet for most of the year was moderate-calorie and rather high-carb. The original reason I went on a low-carb diet was upper GI distress. Probably, I have FODMAPS problems. I can eat a little bit of almost anything without distress, but no way can I eat the recommended six to 12 servings of grains and bushel of fruits and vegetables without bloating and acid reflux.

With little appetite and a lot of adrenaline, though, I could do the recommended high-carb moderation thing, and had to since my stomach wouldn't tolerate anything else. And I ate things like rice, egg rolls, and even a few Hostess cherry pies, which I don't normally eat. It was comfort food, and I needed comforting. (I don't recommend following my lead if a little bad food sends you on a bender or you have a condition that requires strict adherence to a diet.)

Pros and cons:

  • Acne. I had cystic acne, which I hadn't had since my early 20s. 
  • Racing, fluttering heart. 
  • Weight loss. I got down to 118; I look better at 122.
  • I got to eat two Hostess cherry pies and some egg rolls without distress.
  • No tooth decay.


It's hard to say how much was due to stress, diet, or antibiotics. What's really helped everything, though, is probiotics. I've been taking super probiotics at twice the recommended rate and everything has started getting back to normal: my skin is clearing up and my heart feels normal. Yes, I was completely wrong before about gut bugs being unimportant.

I've been eating a little bit more carbohydrate than I did before all this started, though. For years, I've gotten palpitations on very low-carb, and I don't have a need, either for weight control or my stomach, to restrict carbohydrates to an Atkins induction level. That's a good level for some people, but not for me.

There's a lot less stress and more rest in my life now, too. The move is over, my house in Colorado is sold, and in a few days I'll have my new, nicer house completely paid for. My commute is now half an hour and even though I'm working part time, the other day I woke up feeling like I'd been on a long, strange vacation and it was time to go home and go back to work. 

Tuesday, December 15, 2015

What Difference Does it Make Why it Works?

This is the question someone asked me the other day in regards to the good results I've had on low-carb. Beyond just satisfying your curiosity, having a lattice work of mental models, as Charlie Munger puts it, can save you a lot of trouble. Without mental models of (in this case) human digestion, evolution, nutrition research, journalism, medical education, and even politics, all I'd have is just something that works for acid reflux.

A little knowledge is a dangerous thing. Something that works might only work in certain situations, could be unpredictable, could have unintended consequences, or could just be a placebo effect. Knowing how something works reduces the danger.  As Munger's partner Warren Buffett put it, "Risk comes from not knowing what you're doing."

Yet how often are people overconfident when they only know a thing or two? The web is full of bros who cut down on the beer and pizza, got some exercise and lost 40 pounds--and you can, too! Their moms recommend more fiber, less fat and fewer calories, which everybody knows works: it's in all their women's magazines.

Doing what everybody else isn't can be intimidating. Knowing what you're doing, having arrived at the same conclusion from different disciplines, can inform you if you're on the right track and help you stay the course. Here's where the lattice of mental models comes in: facts are connected to other facts. Those facts form the lattices of disciplines and some of the lattices are connected. To pick an example, veganism weaves an interesting lattice with claims of good health, environmental consciousness, and humane treatment of animals. And a juice fast is something that works for certain health problems. But approach the lattice from the disciplines of evolution, or ancestral diets, or digestion, or nutritional requirements, and the lattice of veganism falls apart.

Without a lattice of knowledge--knowing how a system works--all you have is a collection of facts that may be a collection of fairy tales. Like most collections, it can't do anything but be displayed. It's hard to verify unrelated facts, assuming you can remember them. You can't build on them--anything new has to be through trial and error and luck. It's a way of going through life otherwise known as stupidity. I've done it--I have a mouthful of fillings to prove it.

ETA: This could be one reason engineers are so subject to wackiness (e.g., being overrepresented in terrorist groups and fringe religions): they learn pretty much only mental models of engineering subjects, which aren't exactly metaphors for life. Requiring courses in comparative religion, epistemology, and human evolution for an engineering degree could well rid the world of a lot of terrorists.


Tuesday, October 20, 2015

If you can sell potato chips...

If you can sell a bag of potato chips, why can't you sell 1000mg potassium pills?

I've finally found an answer to my cravings and heart palpitations, and unfortunately, it's potato chips. It's not that I've jumped on the safe starch bandwagon, it's just that it suits my current needs:


  • I tend to get low on salt and potassium. The chips have a lot of both, making my heart and energy level feel normal.
  • I'm too wound up about moving to be very hungry. Therefore, I can eat half a bag at a time because I'm not eating much else. I've turned into one of those people who's lost weight eating potatoes.
  • My stomach hasn't been normal since those three courses of antibiotics from my root canal. The chips feel good on my stomach if I don't eat too many.


Downsides:

  • Acne, gas, a bit of reflux, and probably a lack of certain nutrients. 


Potassium isn't one of those nutrients, though. An eight-ounce bag of potato chips has 3727 mg of potassium; a potassium tablet has 99. No wonder I had to pop the potassium pills like candy pre-chips. If I could just get a pill with 4000mg of potassium and chase it with something salt-encrusted, I could get all the relevant nutrients without the acne and other problems.

Potato chips are generally considered junk food, but they do have quite a lot of nutrients, and I usually get the kind cooked in coconut or avocado oil. If a person was carb-agnostic and ate potatoes, what would be wrong with eating the potatoes in the form of chips cooked in natural oils?

Be that as it may, I need to do something other than eat chips. I got a bottle of potassium pills and some probiotics, which helped immediately after my root canal; maybe I need to continue taking them to help absorb nutrients. I'd like to get back to eating normally because I feel better physically and mentally--it's just that  my normal food now sounds like something that would give me a stomach ache. I haven't even been able to look at a fish in months. That, and I have to keep the kitchen clean for potential house buyers to look at. I've been eating lots of take-out.

My plan is to have some eggs or sausage in the morning, a low-carb lunch, dinner if I feel like it, and potassium pills with all of it. Probiotics as directed, and avoid skipping the vitamins.

Thursday, July 2, 2015

Paleo Diet: Eating Differently from Everyone Else is Fine!

I've been seeing more and more articles by women (it's always women) whose heads have exploded trying to figure out life without yogurt and cupcakes. Oh, the shenanigans they get up to: bathroom problems from stuffing themselves with vegetables, paleo baked goods that don't taste the same as ones from the bakery, and especially the irresistible urge to eat "normally."

The technical problems aren't hard to sort out: substitutes like baked goods will taste different because they are different, but an adjustment period of a few months will make those foods taste normal. And whatever you eat, don't stuff yourself. First, though, read a book by Loren Cordain or Mark Sisson to learn about the paleo diet before diving in.

The articles I keep reading, though, have more to do with attitude: the urge to be exactly like everybody else or the urge to be helpless. If you're in the second category, I can't, by definition, help you. If you'd rather be Lucille Ball on I Love Lucy than be Unbreakable Kimmy Schmidt, go for it. But wanting to be like everybody else?

It's not often mentioned, but conformity as a trend comes and goes, and it's all the rage right now. Young people have grown up with helicopter parents, Facebook, and constant contact with friends and family. This is fine if it suits you, but it promotes a great deal of conformity and makes it hard to be different, especially if you haven't known another way. And there is another way.

Just twenty years ago, independence was still a virtue. It had been for decades. Breaking away, finding yourself, and doing you own thing were what people did in the 1960s and 1970s. Young people split from the family home, questioned beliefs, and experimented with different lifestyles and religions. Parents didn't take off work to go to school plays. Boys over the age of 13 didn't need a wingman; at age 16, my ex-jerk was living on his own. As late as the 1980s and 1990s when I was a teenager and young adult, young people moved out of their parents' home in their late teens and early 20s--an older person living at home was called a 30-year-old baby. My parents didn't know what school I went to my first year of college (a lot of kids funded their own education or got scholarships). You could get in trouble for getting personal calls at work. And there was no doggie daycare. In other words, we were more independent.

Young people now can be more independent too, if they want, but it will look different. Mostly, realize that doing something different from your friends and family is fine. Keeping some privacy is fine, too--and may make it easier to do a paleo diet. Friends can and do sabotage each other. Maybe it's jealousy, maybe it's because one person's self-improvement makes them realize they need to get off their own butt and do something. Well-meaning family members who haven't done any research might bug you with their worries. In any case, be easy-going with them about your paleo diet. If your friends go out for cupcakes, just get some coffee or tea without preaching about the evils of flour and sugar. If you've had great results from going paleo, it's tempting to shout it from the rooftops, but most people don't want to hear it. By all means, talk about it with people who really seem interested, make some internet friends or join a meetup group of like-minded people, but don't bore your friends and family.

Think of doing a paleo diet as reviving a recent tradition a lot of us still practice--the tradition of doing your own thing.

Sunday, June 28, 2015

A Good Scare: Missing Paleo Lifestyle Factor

"Life's no fun without a good scare." The Nightmare Before Christmas

Hunter-gatherer life probably consisted of a lot of walking and standing, fairly infrequent eating, and the occasional short-lived scare. This sounds a lot like a trip to an amusement park. I just came back from Elitch's, where I did a lot of walking and standing in line and a little eating and riding the rides, where I felt like I was going to die. It left me wondering what effect it has on people when they never feel like they're in danger. It seems like it's common to feel an adrenaline rush, and then joy, when you escape a danger, real or perceived. At the 1989 World Series, a 6.9 magnitude earthquake struck Candlestick Park and shook the stands for what seemed like minutes, as one reporter described it. The crowd let out a cheer when it was over. People pay to go to amusement parks to have a similar experience: fear, focus, relief, joy, and maybe gratitude that it's over and they're OK. The opposite--life unmixed with any of those things, briefly, is bland. It's just speculation, but maybe brief, scary experiences are important to us. 

Thursday, June 25, 2015

New Bedtime; New Dentist

The new method of getting to bed earlier is working. Last week I had the idea to see going to bed on time as punctuality. (Punctuality is a virtue to me because I so dislike covering for an employee who often shows up very late or waiting on people who are late just because they're diddling around.) I've generally been getting to bed between 10:45 and 11:00. I had a lapse last night because I lost track of time taking pictures to enter a contest for a kitchen makeover. But I haven't been staying up until midnight. I've not only been less tired, but less hungry. I even got up early one morning and worked out. It's been wonderful not to drag bleary-eyed through the day.

*****

I had to find an new dentist since the last one quit taking my insurance. After searching reviews on the internet, and trying to decide which ones could be trusted, I settled on a dentist off East Colfax. In Denver, the character of a neighborhood can vary from block to block. There are places within walking distance of my house that I don't walk to. But East Colfax in general is gritty and marginal. I took the 15 bus (which one magazine recommended for people looking for an adventure), got off on East Colfax, and stepped over broken pavement and under overgrown trees, wondering if I was in the right place. A block later, I was catty-cornered from new luxury apartments and across from an old office building.

The dentist's office looked clean and well-kept (and so did the dentist). They took 18 x-rays and didn't see the cavity that my old dentist said needed filled. I'd honestly forgotten about it and didn't remember it until I left. Hmmm. Maybe lower overhead lets you be more honest, or at least less enthusiastic about pushing procedures. The new dentist didn't seem to think the fillings that needed to be replaced were a big deal; one of them is going to wait until my next cleaning in November. So I can once again say I haven't developed any new cavities since starting low-carb.

This dentist suggested I brush the back of my tongue better to get rid of bacteria, brush more gently for the sake of my gums, and drink diet soda through a straw. And he agreed readily to give me an anesthetic without epinephrine, a drug that's given me heart palpitations for weeks when I've had it. It looks like I've found a winner.