Everything, Everywhere, All At Once
Hey folks-
What a summer! I hear that it was everything, everywhere, all at once for a lot of us. Today's newsletter with a little "what did I do this summer" update, some insurance news, back to school thoughts and a gentle reminder that Winter Is Coming with thoughts about preparing for that.
Seasonal changes, back to school, and preparing for the grey days ahead:
With Portland Public back in full swing this week and other districts getting ready to start or already in the grind, it's a great time to think about a few different things in the health arena! First of all, for folks with young kids just entering school: bring snacks to school pick up. They will be hangry and eat more than you ever thought they'd need. My kids are doing their best to single-handedly decimate the city's peanut butter filled pretzel supply, which ensures they get enough protein to level out the glass cases of emotion that many have as blood sugar crashes when they didn't eat enough lunch because they wanted to play with their friends. We also often make protein oat bites that we throw in the freezer. (As always, note that I consider recipes more like guidelines than rules. This recipe is really easy to sub in different ingredients with- and as pumpkin spice season approached, I can verify that using pumpkin puree as the liquid and leaning on the cinnamon/nutmeg/cloves as seasonings turns them into the pumpkin spice delight that most of us love in fall while bumping up the vitamin A and fiber content). If you or your family members take the summer off from ADHD meds: It's time to work on getting in to the office to get your meds refilled. When you restart them, remember that stimulant medications are generally appetite suppressants. On a suppressed appetite, people may have an easier time with liquids- like protein shakes or smoothies- and may need to set alarms to remind themselves to eat. Most mental health medications also make you more susceptible to the heat! As PDX is generally not air conditioned- especially in the schools- staying hydrated is mission critical. Drinking water is important all year long, but especially during these last few hot weeks adding electrolytes can be helpful too. Here's a couple of links that might be helpful for that: electrolyte loaded mocktails and oral rehydration recipes. There's a reason lemonade and sweet tea are so common in the south- they both help you stay hydrated when the sky feels like it's beaming down sunshine like a weapon! Infectious disease is running amok: Covid rates are pretty high in the PNW right now, and I expect them to continue to go up. Case rates for everything often go up when all the kids get back together, because kids aren't amazing at washing their hands and will cough right on someone's face. For the 6th year running, I'm asking my kids to mask at school- which cuts down on ALL respiratory illness rates.Masks and handwashing work! I will also be making elderberry syrup again, and I'll post up my recipe for that on the blog soon. ("Recipe" is doing a lot of heavy lifting there, I don't think I've ever made it exactly the same twice). As always, my family will be getting our flu and covid vaccines because preventative medicine is way better than reactive medicine. Depending on the studies used, somewhere between 1 in 4 to 1 in 10 people who have a covid infection can have post viral symptoms- and those can include insomnia, anxiety, brain fog, and depression. People with ADHD are at an increased risk for developing this complication. Scientists are still arguing about the numbers, but the theory tracks with my clinical experience over the last 6 years. Here's a preprint article (hasn't been peer reviewed yet) that I think is on the right track. If you can't access it and want to read it, let me know- I have a pdf copy. Two more recent studies I think are super interesting: This study out of Wales about probiotics and mental health (another preprint) which found that folks supplementing with a probiotic had better sleep and mood with less bloating and muscle aches. More than 90% of your serotonin is made in the gut! The secret sauce they used had lactobacillus acidophilus, lactiplantibacillus plantarum, bifidobacterium bifidum, bifidobacterium animalis spp lactis, vitamin D, vitamin C, and zinc- all things you may have heard me talk about before. When it comes to probiotics for mental health, I've been recommending the Target GBx probiotic for years. It has many of the same probiotics as this year's study, and the research- while still small- is really supportive. - I put together a formulary link with some of my most common winter recommendations here; (this is an affiliate link but there is zero obligation- we can chat about whatever brands you're finding or food sources in the office to make sure this is accessible and affordable.) - Probiotics aren't for everyone. Some health conditions, like SIBO and MCAS, can get worse with adding in more bacteria. For people it is a good idea for, remember that you can also make your own fermented foods (as long as your technique is good and you avoid cross contamination!) to support gut health. We can chat about whether this is a good idea for you during a visit. - Vitamin D is hard to get from the sun here in the PNW. Once the UV index is under 3, you cannot absorb this from being outside anymore. Most multivitamins do not have enough vitamin D for the average PNW dweller, as the same brands that sell here also sell in places like Florida. In general, most pacific northwesters can do 2000 IU/day- BUT!! this is a vitamin that your body stores and does have health problems if you get too much of it. We can chat about whether this is a good idea for you during your visit. - Zinc and copper have a complicated relationship, so I don't recommend taking zinc every day for most people. This is more helpful to add in when you're sick. It can also cause heartburn, so we can chat about whether this is a good idea for you during a visit also. - Vitamin C is pretty boring and in general, well tolerated. It can increase diarrhea and no one should be doing 10 g a day without having a genetic screen for G6PD deficiency. This is also pretty easy to get from foods like fruits and drinks like rosehip tea. - Elderberry syrup is super easy and way cheaper to make. You may have missed the harvest- elderberries do grow here, but they ripen earlier in summer. I usually make mine from berries out of friend's yards, but you can get elderberry syrup supplies from local herb shops like Briar Patch Herbs. This is a higher dose plant, and I think a lot of people that don't think it works simply aren't taking enough of it because the premade ones are expensive. I have been known to dump an indiscriminate amount in my coffee, use it for pancake syrup, throw it in oats, use it in place of honey in recipes, etc. If you take too much, you could get a stomach ache/nausea/diarrhea but it usually takes a pretty big amount to get to that point. This study that came out last year about nicotine for acetylcholine dysregulation in long covid: which used nicotine patches in long covid folks. Hear me out y'all- I promise this isn't an episode of Mad Men. Nicotine and covid both work on the ACE-2 receptors, and these researchers theorized that nicotine would help regulate the neurotransmitter acetylcholine, which is really important for energy and a bunch of other stuff. This isn't actually a new thing, either- using a tobacco extract for brain complications of fevers was being written about in 1898 and before (source: King's American Dispensatory) - This is definitely one we should talk about in office, as there are many, many, health risks of tobacco and nicotine. I don't think this will be a good idea for everyone. Full disclosure though, in my ongoing strugglebus of living in a body, I thought about it for months and then decided to try it after hearing a friend's experience of trying it for myalgic encephalitis/chronic fatigue syndrome and talking to my own primary care team about it- and it has been wildly helpful for me. For context, earlier this summer I got my handicap parking permit and was looking into getting a rollator walker. I could not take the stairs and struggled to walk enough to be able to grocery shop. I'm 7 days in to the 2 week protocol and have been able to do multiple sets of stairs, play soccer (a little bit) with the kids, and I haven't had any of the scary heart palpitations in a week. Wild, and neat to see new research back up historical practice. Again, don't try this without chatting with your healthcare team because it is not a zero risk option; and even doing it correctly with healthcare guidance this treatment can make you feel sweaty and have vomiting among other things.
