#I just started a new medication. next step is actual adderall.

[sleepy-gryphon]

Narcolepsy is the dumbest chronic health condition from the outside. It's like. Aww, is baby eepy? Are you big eepy, eepy baby? Need a lil nip nap all the time?

Do meth about it, idiot.

[neednothavehappenedtobetrue]

here are some scripts, ranked in order of how difficult the scripty thing will be to do.

easy mode: "hey Boss, I am, as you know, having a bit of a medical situation, it is not an emergency, but I will be taking X day off to do some routine maintenance"

do not overexplain! do not tell him anything additional! it would be fine if you did, but also, don't!

medium mode (I am terrified of haircuts and therefore hair stylists, sorry about the person I am) "hi! you will notice that my hair is quite dirty. this is because I have been having trouble washing it often because of a medical concern I have that I am getting fixed. I am sorry about this! no, I do not know exactly how long it has been since I washed it, but because of the medical stuff my memory is quite bad, you are probably best equipped to make a guess, as a hair expert person. the medical thing is not COVID-related or otherwise contagious, and I am getting it addressed ASAP. please do not make jokes about this, I am very self-conscious about it.

what's the medical problem? "they're adjusting a medication I take that can sometimes cause fatigue, and forgetfulness and generally make it hard to do stuff" be pleasantly vague! if they ask you really persistently, just say "depression" but probably they will not.

if at all possible, do not tell them that your last hairstylist made a joke about you inadequately washing your hair and you hated it. they do not require this information. practice not oversharing QUITE so much.

hard mode: doctor! (this part gets Really Explicit with the details of my ED, so it is under a cut, only read it if knowing how many meals/calories I eat a week will not trigger you, please do not trigger yourself, I'm sorry but I think if I do not put this here I will not say it, so it needs to go here)

-"hi doctor P, so I made this appointment to talk about a concern I have been having for some time, but now I have two concerns. my initial concern is that I have been experiencing some nausea, particularly bad in the mornings. I am definitely for sure not pregnant. I have been taking phenergan as needed, but not every day. I have only thrown up twice in six weeks, so it is not terrible, but it is also not great. I don't want to take too much phenergan because the hospital doctors told me it could cause heart problems and also I could get too used to it and have it stop working, how worried should I be about those things? sometimes in the morning, I do not feel nausea in my stomach, but I do start gagging or dry-heaving randomly. I have never thrown up from this but it is weird and also means I need to take Zoom calls with my camera off. do you have any ideas or suggestions?

also, a problem that might actually be a bigger problem is that I have recently-ish come to terms with the fact that I have an eating disorder. I have had it off and on probably since I was in my teens. it is not necessarily textbook, in that I am rarely or never preoccupied with my weight and rarely, although not never, restricting deliberately. it initially started when I got the idea that if I lost a lot of weight very quickly, my parents, who were refusing to let me do therapy or psych meds again, would consider it. I never got to a dangerous weight level and I do not remember how long or how much I restricted, but a problem that came from that is that ever since when I am particularly struggling with a mental health issue, like bipolar or depression, I tend to stop eating. part of this problem is that I am very forgetful and literally forget to eat, especially in the absence of real hunger cues. part of the problem is that it is hard to do multi-step tasks when I am depressed, and eating food requires me to stop whatever I am doing, get up, go to the kitchen, figure out what I want to eat, prepare it in some way, and then actually physically eat it. lately, I have been drinking a lot of delivery smoothies because they are easy and digestible, and sandwiches as well. the problem has been particularly bad this past month or so, in a way that I suspect is not entirely explained by those two factors. I am working with my therapist and psychiatrist to fix it. I know that ED can trigger or worsen gastroparesis and I know I should have told you earlier, but I haven't been able to be honest with myself about the severity of the problem.

-this past month, I have been averaging between six and ten meals a week, with some snacks as well. on a good day, I probably hit 1200 calories, on a bad day I don't know, but less than that for sure. on my worst day last week, I ate the meat and cheese inside of half a sandwich and drank some juice, but nothing else. on my best day I drank one and a half smoothies and ate part of a sandwich, which I recognize is still pretty bad.

I am working with my psychiatrist and psychologist on this issue. I have started to take Adderall again, but this is only the second day of me taking it, so meds-related appetite lost is not the issue here.

I cannot get ED professional mental health treatment because, since I am in grad school, my parents pay for all of my medical care and they fundamentally do not believe I have an eating disorder. this is because my mom, who probably has her own ED, thinks 1200 calories is enough for a human per day and also because I am overweight. I saw a nutritionist for three months pre-pandemic and we worked on getting me to eat three meals and two snacks a day, but my parents stopped paying for her because I was not losing weight. I have told them exactly and in detail how little I am eating and they still do not believe I should be eating more, so they refuse to pay for ED-related medical care for me. this is part of a pattern for them, I am working on it in therapy and part of working on it will be figuring out how to pay for my own medical care, but right now I am doing my very best.

I do not know how much I currently weigh or how much weight I might have lost. I do not keep a scale in my apartment, because I am certain I would get obsessive with it. my friends say I look like I have been losing some weight, but it is hard to tell how much.

I know ED is bad for gastroparesis and I am sorry, but I am doing my very best and still struggling.

what I need from you is suggestions on safe ways to get more calories and any other suggestions you have for successfully eating. I am happy to put you in touch with my psychiatrist if you feel that would be useful. my therapist is, just for this week, on vacation. I will see her next week and could connect you then as well.

I cannot see any ED-specific specialists, because my parents categorically will not pay for them. I cannot see a nutritionist or a dietician, same reason. I could potentially see a new gastroenterologist who deals with this stuff in more depth, but my parents will probably Google her, which might pose a problem, and also they have a specific gastroenterologist they want me to see, so they might just... refuse anyway to let me choose my own gastroenterologist. they are like that. however, if you know a GI doctor who knows a lot about both gastroparesis and ED and whose website is not too significantly ED-focused, that might be helpful, or it might not work.

I know this is bad, and I know I need to fix my life so they are not paying for my medical care, I am working on it, I promise. do you have any suggestions?

great! that is a script! also, if she is garbage about this, you can GET A NEW DOCTOR literally at any time, if it sucks, hit the bricks.

[buckyscrystalqueen]

The Resistant Omega: Part 2

Pairings: Omega!Mickey Milkovich x Male Alpha!Reader

Warnings: Swearing, Smut.

Word Count: 4,595

Part 1

~~~~~~~~~~~~~~~~~~~~~~~~

“What do we got?” You asked as you walked up to the back of the stolen, unmarked, pharmacy transport truck that was parked in a blacked out deserted warehouse. Your right hand, Jax, pursed his bottom lip and nodded at the haul.

“We got a big ticket.” He said as you pulled on a pair of leather gloves and stepped into the back. “Oxy, fentanyl, liquid morphine, adderall, albuterol, suppressants, stabilizers, cancer, HIV, Hep C, diabetes… you name it, we got it all.” You nodded your head slowly, and lifted a box of suppressants off the top of a stack to glance at the label.

“Where’s this coming from?”

“Straight from the plant. Manifest says it was headed south.”

“Yea, it headed fucking south alright.” You grumbled as you tucked the suppressants under your arm for Mickey, took the manifest list off the clipboard Jax was holding out to you, and grabbed a couple different boxes of meds to help your neighbor with her leukemia. “Alright, get it out by sundown, and burn it down. I wanna see the fucking inferno in Detroit.” You made sure to pick up a box of fentanyl patches, and a box of oxycodone for your neighbor as well before jumping out of the truck to get as far away from the shipment as possible. “And someone find me the fucking Milkovich boys! Got a Gertie job for those fucking psychopaths.” You shouted over your shoulder as you headed out of the building. The meds went into a secured box in the floorboard under your seat, and you threw your gloves in the glove box before heading home to drop off Gertrude’s meds.

Machine Gun Kelly blared through the speakers of your pick up and you casually smoked a cigarette as if you weren’t sitting on thousands of dollars of stolen medications. You took the long way home, wanting to just enjoy the air conditioner in your truck, as your thoughts drifted to the crazy Omega that showed up at your door. You had dealt with Terry enough times at the Alibi to know he was the reason behind Mickey’s self hatred. That and the rest of the crazy Milkovich family. Typically, you’d just wash your hands of it, but you knew that there would be no way you could. Not now, not that you got a taste of your Omega… who was actually sitting on your front steps when you pulled in to the grass parking lot beside your house.

“You’re back.” You called out as you got out of the truck and opened your lock box.

“Fuck you.” You huffed as you grabbed Gertie’s meds, and left Mickey’s where they were.

“You know, I’m starting to wonder if you know any other fucking insults, ‘mega…”

“Don’t!” He snapped as you started heading next door. “Don’t fucking call me that.”

“Oh, I’ll fucking call you anything I Goddamn please.” You chuckled as you hopped the fence. “Stay there. I got a fucking job for you.” You heard his scoff as you knocked on the door and let yourself in to your neighbor’s. “Gertie? It’s (Y/N)!”

“Back here.” She croaked as loudly as she could from the old dining room that you refashioned into her bedroom almost a year ago. You smiled broadly at the sweet Omega, that was the closet thing you had left to family, in her bed and showed her the boxes in your hand.

“Hi gorgeous. How’s my main girl?”

“Oh, stop.” She giggled as you bent down to kiss her forehead. “You could do so much better than me, young man.”

“Who said I want better than you, huh?” She blushed as you sat down on her bed and started opening up the med boxes. “I got you more pain patches. And I grabbed all your meds…”

“Oh, sweetheart.” She cooed as she gently touched your arm in thanks. “You are too good for me.”

“Here, take these.” You said as you poured out her meds from the med box on her bedside table. “So I can refill them.”

“My daughter is coming later…”

“Yea, well I’m here now, sweetheart.” She rolled her eyes at you, making you smirk, as she took her pills. “There’s a girl. Now, you just sit back and relax for me, OK?”

“You are just a pain.”

“I know.” You laughed as you put a new pain patch on her left shoulder, took off the old one, and checked her water cooler to see how full it was. You grabbed the three empty jugs, and headed out the front door where Mickey had been joined by his brother. “Hey! I need these filled within an hour. At the fucking grocery store, not outta some Goddamn hose, and I want a fucking receipt.”

“What, you think I look like some Goddamn errand boy?” Mickey shouted back.

“Yea, you fucking look like my Goddamn errand boy, bitch! Now get your fucking ass over here and do what I fucking asked before I beat your fucking ass and still make you fucking do it!” You knew only he could hear the slight hint of Alpha in your tone, but you were at least respectful enough not to out his status in front of his idiot brothers. You pulled out a twenty from your wallet and held it out to him as his brothers came over and grabbed the empty jugs off the porch. “Make it fucking quick.” You could hear Mickey grind his teeth together as he snatched the money from you, but you simply walked back inside to finish what you needed. 

“They just get more disrespectful, don’t they?” She asked as you sat down at the small card table in the corner of the room.

“Who, the street thugs?”

“Omegas.” You cocked your eyebrow at her and glanced up as she simply shook her head. “I know that tone. Any Omega knows that tone.”

“Yea, well he’s a stubborn fucker, that’s for sure.” She nodded her head and muted her TV to chat a while while you worked.

“You kids these days have it so hard.” She started with a sad shake of her head. “In my day, it was much easier. There was no suppressing who you were, no hiding from your mate. If you matched, you matched for life. Man, woman- it didn’t matter. But today that’s all that seems to matter.”

“Especially in the South side.” You pointed out as you filled row after row of pill boxes one pill bottle at a time.

“You have an old soul though, (Y/N). I’ve seen some of the Betas and the Omegas that walk through your door. You get it.”

“Yea, well I’m one of a fucking kind.” She huffed and nodded as you smiled up at her while moving on to the next bottle. 

“That you are, my dear. That you are. So tell me about this one?”

“Not much to tell just yet.” You sighed. “He’s got a laundry list of issues and thankfully for him, I got a lot of fucking patience. Suppressants or not, Omegas can only hold out so long when they meet their mate.”

“Waiting makes the heart grow fonder.” She said as she scooted down in bed and carefully rolled onto her side as the fentanyl started to kick in. “Be gentle with him, Alpha. He’s just scared.”

“I know, Gert. I’ve got time.” She nodded her head and closed her eyes to take a nap as you finished up with her meds. The half full bottles went into a fireproof safe in the basement and the pill boxes were put back into place on her bedside table so she could reach them. You washed her dishes, emptied her bedside commode, and tossed a load of laundry in the wash for her daughter just as Mickey came back with the water jugs. “I’m not done with you, but your brothers can go.” You said as you grabbed two of the jugs and gestured him in with your head. “All the way to the back. Keep quiet, she’s sleeping.” Mickey looked up at you, confused as you headed through the living room toward the kitchen.

“Just go.” He said to his brothers as he picked up the third jug and followed you. He stumbled the slightest bit when he saw the elderly woman in the bed, and you glanced over at him.

“Her name’s Gertie. She’s got cancer. I take care of her during the day and her daughter takes care of her at night.” You grabbed the last jug from him and set it with the rest before pulling up her blankets and turning off the TV. “I want you off those shitty street suppressants. You wanna stay on them, you get your shit from me.”

“And who the fuck do you think you are?” He snapped as you put Gertie’s cell phone, and her water cup on the rolling bedside table in front of her. 

“You really want me to answer that fucking question again?” You growled as you stood up and pushed him toward the door. “I’m obviously the only person in the fucking world that you can’t fucking hide from, and the only fucking person you secretly don’t wanna fucking hide from.” He surprisingly stayed silent as you closed Gertie’s front door and locked the metal screen door so no one could break in and steal from her. You headed back over to your truck and grabbed his suppressants before heading up your steps and into your house with him on your heels.

“Look, I fucking get fighting who you are. I see that shit day in and day out on the fucking streets. But you, fortunately or unfortunately have me as an Alpha. So, you’re off those shit suppressants and you take these instead.” You handed him a single months worth and set the rest of the box down on your couch. “You come to me once a month and stock up so I can make sure you’re OK. And other than that, you wanna keep fucking Angie or whatever other beta skanks you stumble upon to try to fight your gay off…”

“I’m not fucking gay.”

“You go right on ahead believing that shit, ‘mega.” You said with a shake of your head as you sat down on your couch and grabbed your cigarettes from your pocket. “But you won’t be buying that shit from the streets anymore. You’ll be cut off by sundown. So you will either need to check in, or admit you’re an Omega and go to a doctor. I got time for you to figure it out; it doesn’t affect me for shit. I got a whole fucking line up of Omegas that would die to be on my fucking dick.”

“Don’t…” He started but quickly shut up when his brain caught up to what he was going to say.

“Don’t what?” You asked as you rested your elbows on your knees. “Don’t call you an Omega? Don’t talk about fucking other Omegas? Or don’t fuck other people at all while you sit and hang me on a fucking hook?”

“I don’t need this shit!” He shouted as he flung the box toward you. “I’m doing just fucking fine…”

“You walk out that fucking door and you are signing your fucking death warrant.” He roared and punched the wall, leaving a giant hole in the plywood and plaster that you would have to make someone patch up later.

“Fuck you!” You nodded your head and picked up the box off the floor.

“See you next month, Omega.” He stormed over and grabbed the box out of your hand before stomping out of your home like a petulant child. You rolled your eyes and grabbed your cell phone to find someone to fix your fucking wall and to find someone else to take your frustration out on.

——

“Lemme ask you somethin. What would you have done if Tara’d giving you the run around when you first met her?” Jax looked over at you as you did bicep curls on and with stolen gym equipment in the shed in your back yard.

“The fuck kinda question is that?”

“The fucking kind that not only doesn’t leave this fucking shed but that I want a fucking answer for. You got a fucking problem with that?” You dropped the dumbbell in your hand on the padded floor and looked over at him with your eyebrow raised, daring him to challenge you on the matter.

“Honestly?” He sighed as he sat down on the bench press bench with a shrug. “Not a fucking clue. Why, what’s up?”

“Stumbled upon my fucking Omega by chance.” You started as you picked up your 30 pound weight with your other hand. “But fucker’s so far in the Goddamn closet, I don’t know how he can see the fucking light five inches in front of his fucking face.”

“Anyone I know?”

“Wouldn’t fucking tell you one way or another.” You said with a shake of your head. “But I know, he knows whose fucking bed he belongs in. He just wants to fucking fight for the sake of being fucking defiant.”

“So put your fucking foot down.” Jax said as he racked the bench press bar, and sat up to look at you.

“What, and be that fucking Alpha? Fuck that. I may be a fucking tool, but I’ve got some fucking semblance of respect for the fairer class.”

“Look, I honestly don’t know what to fucking tell you here.” He said with a shake of his head. “My Omega bowed down the second she found me. I don’t know any other Omega’s that haven’t done the same thing. ’s’far as I know, you’re the first one with a stubborn Omega.”

“Seems par to fucking course.” You said as you put the dumbbell back on the rack and got up to do some pull ups. “I wouldn’t be slinging fucking meds if shit went fucking easy in my Goddamn life.”

“Oh, come on, man.” Jax laughed as you grabbed a 45 pound plate and a weight belt on your way out of the shed. “You know you’d be bored as fuck had you actually done something fucking productive with your life.”

“Yea, probably.” You finished strapping the weight to your waist and glanced out toward the street to see Mickey heading away from your porch. You whistled loudly, and waited for him to turn around before shaking your head to call him toward you and jumping up to grab the bar above your head. “You need to head out.”

“Huh?”

“Out. Now.” Jax looked over at you and shook his head as he got up and put his weight down on the rack.

“I’ll pick up the collection.” He sighed on the way out the back where he parked his truck in the alley. You nodded your head and kept counting your reps, watching Mickey like a hawk as he peeked into your shed and dipped inside. Once in the safety of the box, he physically relaxed, sat down, and watched you finish.

“It been a month already?” You asked as you held yourself up in place for a few seconds.

“Needed a place to go.” With a sigh, you lowered yourself to dangle and dropped to the ground.

“Cops?” He shook his head and ran his hand across his short, brown hair. You used the weight plate to lift his chin and waited for him to give you a real answer.

“Ok, I just wanted to fucking see you.” You nodded your head and tossed the plate in the air to shift your grip on it so you could put it away.

“Angie quit putting out?”

“I… I wouldn’t know.”

“Acceptance?” You smirked when he stayed silent and grabbed your nearly empty water jug off the floor. “Lets go then, ‘mega. I need a fucking shower before we head over to Gertie’s.”

“We?” He said as he got up and followed you out of the shed.

“We.” You repeated. “You may be a fucking thug, but you’re with me and you will respect the fucking elders of this fucking community. That’s my fucking job, and as my fucking Omega, you will follow that path. Respect the elders, keep dicks in line, and beat the shit outta anyone that you fucking want to. I don’t give a fuck all otherwise.”

“You act like we’re fuckin’ together or some shit.”

“I’m gunna let that one slide.” You stopped in front of your washer and stripped out of your sweaty gym clothes. You could hear Mickey’s jaw drop behind you, which made you smirk as you turned around to look at him. “Come here.” He dragged his eyes up your body and took a hesitant step forward but two hesitant steps back. “Mickey. Come here.” With a heavy sigh, he closed the distance and stopped right in front of you. “Close your eyes.”

“The fuck am I gunna…”

“Close your eyes!” You barked. When he did, you reached out and grabbed his hand. “Stop thinking so fucking much.” You placed his hand on your chest and slid it down slowly, watching his face for every subtle reaction he was going to give. He stiffened even harder when his fingertips touched his cock, but you pushed him a little farther to wrap his fingers around your length. “Treat it like it’s your own.” You said as you reached up with your free hand and cupped the back of his head. You let out a tiny grunt and curled your hand on the back of his neck, which apparently was just what he needed.

“Like that?” He asked as he started to stroke a little harder.

“Just like that, baby boy. Just like that.” You nodded your head and tilted your head to kiss his neck but he actually turned toward you and captured your lips with his. He pushed you back against your washer and got a little more dominant, which you were more than happy to let happen until he really found his footing. You gave him the lead, letting him silently tell you how far and how fast he was willing to go, which apparently was a lot farther than you expected.

“Alpha… Fuck me.” You wasted zero time spinning him around and pinning him to the washer. He scrambled to get his jeans undone as you yanked off his shirts and tossed them on the floor. When he got his pants around his ankles, his arousal dripped down his legs, and you moaned at the sight.

“Fuck, Mickey. Goddamn you are one handsome son of a bitch.” You bent down long enough to bite his ass before bending him over and sliding the head of your cock in his tight hole. He swore loudly and you shushed him gently with a nod of your head. “Easy… breathe, Mick.”

“How the fuck am I supposed to fucking breathe… FUCK!”

“Yea, that’s how your supposed to fucking breathe.” You huffed with a smile as you pulled your hips back and slowly pushed them forward again. You stretched him out inch by inch, loving every little noise he made. You cut him a break at half way and instead picked up the pace.

“More.” He growled as he clawed at the lid of the washer.

“I’ll fucking ruin you.” You promised as you reached forward and laced your hand with his.

“Do it.” He said as he turned to the side to look at you. “Do it.”

“Fuckin’ shit… you are killin’ me.” He moaned and pushed his hips back toward you, and you could feel the desperation seeping from his soul.

“Alpha…”

“Goddamn it.” You let go of his hand, grabbed his hips, and pushed your cock all the way in. He screamed and came on the spot, as his ass spasmed and tried to adjust to the stretch. His legs started to twitch as he laid his upper body down on the cool washer and nodded.

“(Y/N), please.”

“Hang on, Omega.” His eyes rolled back into his head as you picked up the punishing pace you wanted; the animalistic Alpha slipping all the way in to the forefront of your mind and taking what it wanted from the Omega beneath you. He reached back and grabbed your wrist, tightly, and it took you a moment of looking into the blue eyes staring back at you after the second time he came for you to realize that this moment was the closest Mickey Milkovich had ever gotten to another human being. “Fuck… alright, hold on.”

“No… no, please.” He whined as you pulled out of him, which you instantly regretted doing.

“Patience, baby boy. We’re just going upstairs.” He nodded his head and let you turn him around to head into the living room. You smacked his ass as he headed up the stairs and smiled at his scowl as he looked over his shoulder.

“Fuck you.”

“That a promise?” Your smile grew at the sight of his, and you playfully pushed him down on your bed. “Get that ass up.” 

“You want this ass up?” He teased as he spread his legs out across the bed so that he was flat. “That what you want?”

“You’re pushing buttons, Omega.” You warned as you stroked your length slowly. “Better get that ass up.”

“Or what? Big bad Alpha gunna show me what he’s made of?” You reached out and spanked him as hard as you could, which sent a shiver up his spine, and made slick pour from his ass, and his dick throb on the bed.

“Present, Omega.” You demanded as you kneeled down behind him. He groaned and complied  instantly, adding in a small wiggle of his hips as he gripped your metal headboard tightly. “Oh, you are a fucking smart ass, baby.” You smirked and bent over him to nip at his ear lobe. “I’m gunna have to fuck that sass right out of you, aren’t I?”

“Fuckin’ try it.” Your smirk grew as you sat up and pushed his ass down to where you wanted it.

“Oh, I fucking will.” His back arched toward the bed and he moaned, gutturally as you slid yourself back until you bottomed out. You picked up the same punishing pace, pulling every single little noise that you could out of your Omega as you pulled him higher, and higher toward oblivion. Sweat dripped down your chest as you tried your damnedest to make sure Mickey’s first knot would be magical but fuck if he was making it hard. His body was damn near close to perfect and his whimpers went straight to your cock, making your knot swell more and more with every pump. You wanted to hold out longer, you really did, but fuck if he didn’t have the tightest ass you had ever had.

“You want my fuckin’ knot, baby?” You growled as you gripped his hips tighter. “Wanna take your first knot? Feel it split this fucking perfect ass open?” 

“Please…” He nodded frantically and started to beg, incoherently. He found your eyes again and his face contorted with his next orgasm, and you forced your knot in to feel him come around you. Mickey tensed and almost instantly went limp and you sighed and shook your head.

“Oh, baby boy. What the fuck am I gunna do with you?” As carefully as you could, you laid the two of you down on your side and wrapped your arms around his chest. You softly started calling his name as you leaned back and grabbed your cigarettes and the small fan you had on your bedside table. “Hey, Mick, come back to me.”

“The fuck?”

“Hey, there he is.” You kissed the back of his head and lit a cigarette for the pair of you to split. “Welcome back to the land of the living.”

“Fuck happened?”

“You passed out. From the pain, or the orgasms, I’m not quite sure.”

“Holy shit.” You nodded your head and held the cigarette in front of his face. He gripped your hand with his shaking hand and brought the butt down to his lips. You kissed his shoulder and very gently brushed your fingertips across his stomach as he exhaled and let his hand fall back onto the bed. You took a long drag of the smoke and leaned behind you to grab an ashtray as Mickey reached down and held your arm to his chest. “Did you always know you were gay?”

“I did not.” You told him as you set the ashtray down in front of him and ashed the cigarette in your hand before holding it up for him again. “I didn’t realize it until I presented. And at that point, I was just a horny fucking teenager with a huge cock and endless opportunities on where I could put it.”

“You’re the first Alpha I’ve been with.” You nodded your head and kissed his shoulder, reassuringly.

“I know. And I know that that terrifies you. I know that you are fighting an entire lifetime of homophobia from your piece of shit pop, who tried to beat my ass for being gay not to long ago in the can. I know that you can’t accept what you are just yet outside the walls of this house and that’s OK. I’m not asking you to move fucking mountains, Mickey. You wanna come here and be who you truly are for a couple hours a day, please. Feel free. My house is your house as far as I’m concerned. But there is an end game here. You are my Omega and one day, I will put my mark on this pretty little neck of yours. Won’t be today, won’t be tomorrow, and it damn sure won’t be until you are ready. But you have to accept who you really are first. And you have to love yourself despite what the people around you think. Shit, you think I have an easy time running the streets when I swing both ways?” He shook his head before taking one last drag of your cigarette so you could put it out.

“Why’d you have to let me in to your house?”

“Would you prefer I let those two fucks beat you to death?”

“Obviously.”

“Oh, well excuse me, mother fucker. Next time you go running past my fucking house, I’ll make sure to trip you so they can catch up faster.” He tried to elbow you in the side but you were too close and your arm was on top of his. “I’ll warn you now, you don’t wanna jar this fucking knot outta your ass or your gunna know the true fucking definition of pain.”

“Fuck you… I’m fucking cold.”

“Alright, don’t wiggle, don’t clench.”

“Don’t… whoa, don’t fucking do that!” You smirked as you hugged him closer to you and used your leg to pull the blanket closer to you again.

“Hey, you were bitching about being cold.” You spread the blanket over both of you and moved the ashtray out of the way as Mickey snuggled into your arm under his pillow. “Better?”

“Better.” With one more nod, you laid your head down on the pillow behind him and sighed.

“Get some sleep, baby boy. I gotta go over and check on Gertie and make sure she eats and takes her pills.”

“Such a fucking do-gooder.”

“Fuck you, go to sleep.”

Part 3

[justanotherdeadgirlwalking]

That is Just the Saddest F**king Thing I Have Ever Heard.

TW obviously DEH is about a kid’s suicide, so it has those themes

other parts :)

Part One.

Cynthia said I had to go to school today. “It’s your senior year Connor,” she said, “you can’t miss the first day,” which was just complete bullshit. I tried to compromise, “I’ll go tomorrow,” I told her. No, I had to go. Mom just wanted to get me out of the house after watching me sleep and sit in my room all summer. “Today’s a chance to go make some friends” she told me.

Look it’s not my fault that I don’t have any fucking friends, and it’s not my fault that I can’t make friends because everyone thinks of me as big, bad Connor Murphy, the freak. I’m not a freak. People just have this false idea of me in their head and have never taken the time to actually get to know me. I’ve always been a hot topic of rumors, even though I’ve never done anything really worth talking about. Except the incident in second grade. Someone explain to me why something so stupid that happened when I was 8 years old is something people still use to talk shit about me. It is still a story that gets told from time to time, “oh stay away from Connor Murphy, he’s batshit crazy. He once threw a printer at Mrs. G. because he didn’t get to be line leader” That’s not the whole story. No one knows what really happened because they weren’t even there. I mean, yes I was upset that I didn’t get to be line leader, even though it was my turn, and yes I did shove the table that the printer was on, which caused it to fall. So, I mean, I guess I threw the printer in a sense, but what does it matter? I was a child. Do you know how much embarrassing shit people did in elementary school that doesn’t get talked about because, well geez, they were children, and they’ve grown since then. Fucking Alana Beck peed her pants probably seven times that year, but we don’t talk about that. Whatever.

Most likely, no one is going to be telling that story this year. There’s some new hot gossip about me. See, I spent my junior year at a private school. It was awesome, I actually had a friend, and I was doing well, but I got kicked out. They did random locker searches, and I had weed in my locker, barley half a gram. The best part is, the weed wasn’t even mine. Not that anyone cares, not that anyone is going to ask, or listen to my side of the story. Ironically, they found so much Adderall, in probably 50 lockers, and they got away without so much as a warning. So, pills are okay, I guess, but marijuana isn’t.

Look, unlike what my parents might think, it isn’t dangerous or addicting or bad. Newsflash weed doesn’t hurt anyone. You can’t die from being too high, but pills, you can die from taking too many pills. I told them that too, I showed them statistics and research to convince them marijuana isn’t bad, they sent me to rehab to help with my ‘addiction,’ but all it did was teach me new, worse habits and prescriptions for mood stabilizers.

I’ve always been on medications to try to help me with the depression and paranoia, but I don’t like how they make me feel. Usually, I keep the pills hidden so Mom and Dad don’t catch on that I’m not taking them. I just prefer weed anyways; weed just calms me down, while the other crap I’ve been prescribed puts in a zombie like daze. I just smoke a little weed every now and then to help me get through the day.

People are going to say whatever they want, but I guess that it doesn’t help that I smell like pot anyways. That smell, no matter how many times you wash your clothes or spray your belongings with ferbreeze, never goes away. Regardless, I know I’m not the only stoner, not that I’m a stoner, but most people act like it’s a fucking personality trait to smoke. They’ll go online and post pictures of their bowls and blunts, thinking that they’re cool, but I’m a burnout freak because I smoke.

Despite my protests, I found myself in the passenger seat of Zoe’s car as she drove me to school. Some people might think it’s lame to be driven around by their little sister, but I fucking hate driving. I get too distracted, plus, other people drive like absolute nimrods. I got enough stress in my life, why add the stress of driving.

The first day of school is always a waste; you never do anything meaningful or important. People just spend the day catching up with friends, talking obnoxiously loud about their trip to Italy, or how they built houses for the homeless, and you just do ridiculous ice breakers and make nametags. It’s not like I’m going to learn anything, I’m just going to sit through hours of “two truths and a lie.” Plus, I’ll have to sit through the embarrassment of no one volunteering to guess which of my statements is the lie. No one wants to waste their time with that. Though, I will admit, I came up with some good ones this year, “My birthday is 420, I like to draw, and I have a dog.” The lie, obviously, is that I have a dog. I’ve always wanted one, but Larry has always said no, “they’re too messy.”

I try not to let other people bother me. I just focus my gaze straight ahead, walking as quick as I can to my first class, avoiding obstacles the best I can. In my opinion, people that stand in the middle of the hallway to have their conversation do not deserve rights. Hi, you, and your conversation is not more important than me trying to get to class. Have some fucking decency and at least move over to the side, Jesus Christ. On the bright side, people do tend to move out of my way. It might be out of fear, but it’s convenient. I put my head down as I cut through the middle of two people. “Hey Connor”  a boy calls, “Nice hair length,” he continues, “very ‘school-shooter’ chic.” Wow, was that really necessary; did they really have to stop me to tell me that? That’s what I need too: Connor Murphy, not only a freak, but also looks like a school shooter.

I stop in my tracks with a heavy thud as my boots hit the ground. I whip around to face the voice. I look up with a narrow gaze and see Jared Kleinman and Evan Hansen. They are two nobodies like me, but I guess they think they’re better than me.

“I was just kidding” Jared stutters, “It was a joke.”

“Oh, I know.” I say, with no emotion, “I thought it was funny, I’m laughing can’t you tell?” I close the space between us until I’m in his face, towering over him. I’m not a scary person, but I am 6’3”, so my height tends to intimidate people, plus I really like wearing all black. My physical appearance is really a shell of armor, no one knows how sensitive I really am. At least, people can’t walk all over me if they are scared of me. I stare him down, “Or am I not laughing hard enough for you” I say.

I found, that if you stare at someone long enough, they will leave you alone. Mostly, because they are creeped out. It must be working, because Jared takes a step back, “you’re such a freak,” he says as he turns to make a run for it.

Evan’s still standing there, laughing quietly to himself. “What the fuck are you laughing at” I snap at him.

“N-nothing” he stutters.

I turn to him, “do you think I’m a freak.” He’s still laughing to himself. “You’re the fucking freak,” I yell as shove him.

I pause for a moment, looking down at Evan, who is now on the ground. He looks scared, like really, scared. Does he think I’m going to beat him up? Has he been beaten up before? Who hurt him? I scan his body quickly; this kid is already in a cast. Great, I just pushed an injured kid. Maybe I really am a freak. What the fuck is wrong with me? I collect myself and quickly walk away. I don’t have time to deal with this. It’ll probably be a few hours before this goes around the school.

I make it to my locker, my eyes are still on Evan, who is still on the ground. He’s been on the ground for a while, surly he should’ve stood up by now. Fuck, did I break his legs? Zoe walks up to him and helps him up. He’s fine. I watch as Zoe talks to him for a few minutes. Even my own sister isn’t on my side. Thanks Zoe, I’ll remember that the next time you want me to cover for you when you sneak out. Mom and Dad might think I’m the fucked-up child, but they have no idea what kind of shit you get into.

Each class is a blur as I sit through hours of introductions. Finally, its time for lunch. I don’t have friends to sit with, and I don’t like to give people the satisfaction of watching me sit by myself, so usually I spend the period in the library. I’m safe among the stacks. Books can’t judge you, but they can be an escape from your fucked reality. I can’t find a place to sit in the main library, so I go in the back by the computers. There’s a kid talking on his phone, but I don’t think he’ll mind my presence. I find a seat in the corner and lose myself in a book.

Suddenly, I’m snapped back into reality when the printer goes off. It scared the shit out of me. I look at the paper the printer is spitting out, “Dear Evan Hansen” the top reads. I look over to see Evan hunched over a laptop, talking to himself. I don’t think this kid has any friends either, besides Jared, but Jared’s a dick. Evan isn’t a freak like me, but he’s just someone always in the background. Everyone knows who he is, but no one cares.

I should probably apologize to him about earlier.

I grab the paper and walk over to him, “Hey.” He looks up at me, startled. “So, what did you do to your arm anyways?” I ask him.

He looks down at is arm as if he’s confused as to what I’m talking about. “Oh”, he stammers “I fell out of a tree.”

I look at him, expecting him to say more, he doesn’t. “Well, that’s just the saddest fucking thing I’ve ever heard” I tell him.

“I know,” he says.

I look at his cast, its blank. I guess it makes sense, since he doesn’t have any friends. “Hey, no one’s signed your cast yet; I will,” I say.

“No, no you don’t have to” Evan whines.

“Do you have a sharpie?” I ask. He stares at me for a moment before he starts digging in his backpack and pulls out a marker, handing it to me. I grab his arm, and he winces. I ignore that and write my name as large as I can along the side of his cast. I figure, no one else is probably going to sign it, so I might as well take up as much real-estate  as I can. “There,” I say, “now we can both pretend that we have friends.” Evan stares at his cast.

I remember that I still have his paper, “is this yours?” I ask, holding it out to him, “I found it on the printer, it says ‘Dear Evan Hansen,’ that’s you right?”

“Oh, that’s nothing, um, it’s stupid.” He tries to grab the paper from me, “It’s just an assignment”

I pull it out of his reach and look at it, my eyes land on Zoe’s name, “because there’s Zoe” I read aloud, “Did you write some freaky shit about my sister?”

“No, no” He stutters, trying to rip the paper out of my hand, “Why would I do that?”

“You wrote it because you knew I would find it” I snap, “So I would freak out and you can tell everyone that Connor Murphy is a fucking freak.”

“No” Evan cries.

I shove the paper into my pocket, “Fuck you” I say as I storm away.

I walk out of the library, and right out of the front door of the school. There’s still two periods left, but I don’t care, I’ve had enough of today. I keep walking, I don’t even know where I’m going. Eventually, when I’ve put enough distance between me and the school, I pause to pull out my headphones and put on some music. I don’t even care what I’m listening to, it just has to be loud enough to block out my thoughts.

I don’t feel bad about pushing Evan anymore; honestly that kid deserves way worse. He had to know I was in the room with him. No one is that oblivious to the world to not even notice that they’re not alone. Why would he write about my sister? Like does he have a weird fantasy about her that he just had to get down, and print out? Look buddy, most people keep their private thoughts in their head, where they belong.

I eventually reach a park, its oddly empty, but I guess all the children are still at school. I sit on a bench and throw my bag onto the ground, it rattles with impact. I pick it up to investigate the sound; I dig around until I find the source: a prescription bottle. I forgot that I had put my meds in here. I hold  the bottle and read the label, it’s good old Prozac. I have refused to take it ever since it was prescribed to me. If you look it up, it has so many warnings and side effects listed, it doesn’t even seem worth it. Like there’s a small chance this will make you feel better, but there’s an even bigger chance that it might kill you, or make you want to kill yourself. The irony! They give you the medicine because you think about killing yourself, but the medicine makes you want to actually kill yourself. Do doctors even care about you, or do they just write you a prescription, so you go away?

I’ve never taken a single dose of this medication, outside of the hospital where they basically force it down your throat, but now seems like a good time to. I feel so numb, what does it even matter, it’s supposed to help me right? I swallow a pill, dry, and then another, and another. I keep swallowing them until I run out of pills. I throw the empty bottle on to the ground. Suddenly, I have a killer headache; I can feel my heart pounding, thoughts are racing in my mind. I lay down on the bench and take a deep breath.

[deadcactuswalking]

REVIEWING THE CHARTS: 06/03/2021 ("BED”, Digga D, Kali Uchis)

It’s finally a really short filler week on the UK Singles Chart but not one without its importance as we’ve got some real interesting stuff to talk about this week, even if there are only six new arrivals. Olivia Rodrigo’s “drivers license” is at #1, and whilst I may not be able to post this on Twitter because I’ve been locked out – don’t ask why – this is still REVIEWING THE CHARTS.

Rundown

So, a lot of our debuts are gone, including “test drive” by Ariana Grande as well as other bigger hits dropping out of the UK Top 75 – which is what I cover – including “Burner on Deck” by Fredo featuring the late Pop Smoke and Young Adz, “i miss u” by Jax Jones and Au/Ra, Taylor Swift’s re-recorded “Love Story”, “Before You Go” by Lewis Capaldi, “Shallow” by Lady Gaga and Bradley Cooper and “Perfect” by Ed Sheeran. There are also a handful of fallers across the chart like Fredo’s continued drops as “Money Talks” with Dave is at #28, “Let’s Go Home Together” by Ella Henderson and Tom Grennan off of the debut to #34, “Love Not War (The Tampa Beat)” by Jason Derulo and Nuka at #36, “34+35” by Ariana Grande at #40, “Good Days” by SZA dropping hard with the streaming cut down to #46, “Mixed Emotions” by Abra Cadabra at #54, “Watermelon Sugar” by Harry Styles at #60, “Didn’t Know” by Tom Zanetti off of the debut to #68, “Siberia” by Headie One featuring Burna Boy at #71 and “willow” by Taylor Swift at #72. What’s probably more interesting are our gains and returning entries, as for returns, we’ve got “ROCKSTAR” by DaBaby featuring Roddy RIcch back at #75, Wilkinson’s 2013 drum and bass track “Afterglow” featuring uncredited vocals from Becky Hill back at #74 for whatever reason, “Higher” by Clean Bandit featuring iann dior at #70 and “Goodbye” by Imanbek and Goodboys coming back strong at #59. Our gains are also pretty unique, as we have some second winds for “Looking for Me” by Paul Woolford, Diplo and Kareen Lomax at #67, “Loading” by Central Cee at #61 and “Roses” by SAINt JHN and remixed by Imanbek at #55. We also have a handful of climbers within the top 40, like “All You Ever Wanted” by Rag’n’Bone Man surging up to #33 off of the debut, which I’m pretty happy about as it’s a really good song. I’m less over the moon about “Little Bit of Love” by Tom Grennan at #27, “Believe Me” by Navos at #25 and finally, “My Head & My Heart” by Ava Max up to #19. There’s not much movement above that however, so let’s get into our new arrivals, starting with something I didn’t think I see here this soon.

NEW ARRIVALS

#65 – “SugarCrash!” – ElyOtto

Produced by ElyOtto

I love doing this show because I find out more about genres I’d usually tend to avoid. I’m not the most knowledgeable person about Afroswing or really, a lot of the house that ends up charting on the UK Singles Chart. I think I know my fair bit about at least the mainstream of a lot of the UK drill stuff, but what I really would consider myself somewhat specialised in is hyperpop. I’m probably too old to enjoy any of it as much as I do but that may just be why I have a connection to this overly online, digital scene of SoundCloud producers and rappers making pretty obnoxiously mid-2000s-influenced electropop, as it really does feel like a retreat to a simpler time with all of the angst of the emo-pop being made around the same time. The hyperpop scene and bubblegum bass as a whole has always felt inclusive, which I think is one of the main reasons why it’s big with teenagers nowadays, because there really isn’t much of a limit in the genre or at least the scope that we’ve found as of yet, whether it be integrating elements of ‘hexd’ or brostep or trance or what have you. Whilst companies may want us to be nostalgic for the 1990s, I think most people are taking a couple steps forward here, and it’s creating some genuinely great music – some of the time, at least. Hyperpop has birthed many SoundCloud-based sub-genres, or I guess micro-genres, including one of which being glitchcore, a glitchier, more off-the-wall brand of cloud rap with a lot of high-energy trap production and nightcore-esque pitch-shifting. I see some brands of infighting amongst people who listen to hyperpop and glitchcore seeing as glitchcore has arguably taken off a bit faster than other more electronic or pop-focused scenes, but I see that as evolution of a scene more than anything. 100 gecs sounds nothing like A.G. Cook, anyway, it’s pointless gate-keeping at this point, especially when TikTok gets their hands on this random kid from Canada. In a genre full of pioneers, this young Canadian guy’s debut single is what gains traction and for what it’s worth I’m happy for the guy but I’m not a fan of the song at all. This does feel like a parody if anything, with its fast-paced gecs impression and admittedly pretty ethereal synth patterns pretty drowned out by lightweight trap percussion and this ElyOtto guy who really isn’t a presence at all, especially if he’s going to pitch himself down and further into the instrumental on the outro... of a song that’s already only one minute and 20 seconds yet runs through two choruses and a verse, of which nothing really is said of substance. People like blackwinterwells and osquinn make similar music especially in terms of lyrical content but there is something to be said about their honesty and somewhat paranoid tones that creep in, whilst there’s nothing really emotionally convincing about this guy’s delivery or content, as while he may make the same semi-ironic references to self-harm, pain medication and Gen Z culture as they do, he doesn’t really have any tact and it feels overly self-aware to the point where I refuse to believe anyone outside of ElyOtto can really enjoy it fully. It makes perfect sense that this started off as a “short soundfont test” and really, it probably should have stayed that way. There’s a lot to be enjoyed in hyperpop but if this isn’t a satire and is a genuine attempt at approaching the scene, I’d be genuinely surprised. That said, his song “TEETH!” is legitimately good with the exact same length, so maybe I’m just full of it. Either way, I’m not a fan. Sorry.

#56 – “AP” – Pop Smoke

Produced by 808Melo and Rico Beats

Another posthumous Pop Smoke single, except this was actually recorded well before his death and probably finished before to boot, as it’s attached to a film, Boogie, that he will actually star in. With 808Melo on production, it’s guaranteed to have at least some hard-hitting drill production and, yeah, I mean, it’s fine. It’s got a pretty eerie vocal sample behind all the murderous lyrics and pretty busy drill percussion with some great 808s, even if it and the sample feels a bit too loud in the mix when Pop Smoke’s rich voice feels buried. It’s just gunplay, really, and a bit of flexing and references to his older songs, as he makes a call and it’s war and he’s off that Adderall. It’s sad that from now on, any material we get from Pop Smoke will be his leftovers and throwaways. That said, this is fine, perhaps a bit too long, and it could be worse – I mean, it originally leaked with a Rich the Kid verse, it REALLY could have been worse. Once again, RIP Pop Smoke and I hope 808Melo gets his YouTube channel back if he hasn’t already.

#50 – “Pierre” – Ryn Weaver

Produced by benny blanco, Ryan Tedder and Michael Angelakos

The UK Singles Chart is changing, and I think that’s what makes this such an interesting week as there is genuinely some stuff here we’ve never seen debut on the chart before – or anything like it – and that’s exciting to me. You probably know Ryn Weaver from “OctaHate”, a brief 2014 viral pop song written by Charli XCX and produced by Cashmere Cat that led to a debut album the next year and thanks to presumably TikTok, a deep cut from said album has now debuted in the top 50. Now I hadn’t heard of her before looking at the chart about an hour ago, so I can’t tell you much of anything at all about the California singer. I’m not really a fan of “OctaHate” but I do have a fondness for that janky electropop production from the mid-2010s – “Gold” by Kiiara is a hill I’d die on – so with production from Michael Angelakos of Passion Pit, I’d hoped “Pierre” would be pretty cool and, yeah, it’s pretty odd, actually. It seems like a pretty ballad but with a very fast-paced, raspy delivery from Weaver and some choppy production that soon tenses in the chorus and I’ve got to say, while I’m not 100% on the mixing, I can get behind the concept here, especially with some multi-tracked vocals from Weaver. The song itself is about trying to run away from her feelings for a lover that never really went away, particularly as she hooks up later with a man called Pierre who speaks in broken English, which gives a lot of reason for the tense pace of the song, even if that is undercut by the production being muddy and awfully willing to kill its momentum in the outro as there’s never really a proper climax. That said, it’s fitting for that final line, “I’ll come around”, which can be interpreted as about moving on or complacency – just coming back to that guy after years of searching for someone else. I do like this – or at least what it’s trying to do – but I feel like it’d enjoy it more with less clutter, particularly in that chorus, which could really elevate this but as it is, it’s fine.

#45 – “telepatía” – Kali Uchis

Produced by Albert Hype, Manuel Lara and Tainy

Okay, so alt-pop all the way from Latin America, that’s also a first... except not really, as ROSALÍA has charted before, if only off of the back of Billie Eilish. Regardless, this is a really high debut for a global hit from Colombian-American critical darling Kali Uchis, someone I’m always glad to hear from. Admittedly I did not check out that last project that was a return to a lot of the Latin American music, including reggaeton, she took early influence from. That debut studio album is mostly an English-language neo-soul record so I appreciate the risks taken, even if I personally didn’t check it out. I probably should though, because this bilingual streaming success “telepatía”, is pretty damn smooth with some of the signature fuzzy keys you’d hear from any Kali Uchis song, somewhat reminiscent of Tyler, The Creator in all of the elegant piano ambiance and soul drums that cut the line thin between live and programmed, but sound quite either way. I especially love the flushes of Latin guitar in the chorus but really, Uchis’ silky voice is what shines here, especially in the subtle, seductive double-tracking and how smoothly it switches from Spanish to English. It’s not perfect, I mean, the transition from chorus to second verse and back again is somewhat awkward, and it does feel like it runs a little short. I was honestly expecting a guitar solo or something but we get very little of anything after that final chorus. Given that I know Tainy mostly from his work with J Balvin – and I’ll admit, also mostly from his work on the Sponge on the Run soundtrack – I’m pretty pleasantly surprised with how this has meshed together and I do really hope this sticks around.

#23 – “Bluuwuu” – Digga D

Produced by Glvck

We didn’t get an album bomb from Digga D, bless the Lord, but we did get this one single and... do American rappers make genuine death threats on their top 40 singles? Just wondering, because this has several references to rival gang members and how he’s going to hurt them in one way or another. That would be fine if it were convincing, but this guy really isn’t, especially if he’s going to do the silly “bluuwuu” ad-lib in the chorus over one of the least interesting drill beats I’ve ever heard. The 808s don’t slide notably, the percussion is like a template and there isn’t any energy to this... which is fine, because it’s very much just about gang violence, half of it censored. That said, it crosses the line from intriguing detail to possibly too detailed in a way that’s just unwarranted over a boring beat and with the tendency to go off-topic with his flexing ever so often. I’d probably rather listen to the posthumous Pop Smoke single over this if I had to choose, at least that beat is, you know, good.

#20 – “BED” – Joel Corry, RAYE and David Guetta

Produced by Giorgio Tiunfort, New Levels, David Guetta and Joel Corry

I thought these guys were literally famous for just being producers, why does a song by two producers need two extra producers and if it really needs them, why aren’t they given a lead artist credit as well? Oh, right: name recognition, even though neither Corry or Guetta have ever made anything worth recognising. This song with RAYE, personality-void guest singer, relies on the line, “I got a bed, but I’d rather be in yours tonight”, because it’s a sex jam in one way or another, even though there are no stakes to that chorus line at all. Yes, I know RAYE has a bed; she probably sleeps very comfortably on it. She probably bought it from Premier Inn. Maybe they were having a sale. There’s no point in clarifying that you have a bed – in fact, a more interesting lyrical turn would to maybe bring some stakes into it by saying that RAYE does not in fact have a home, and the intimacy with unnamed man keeps her afloat in times of hardship. This is really just me stalling because this may be our highest debut but that does not mean it’s worth talking about. “BED” doesn’t really do much more than it’s supposed to. It’s got some vaguely 90s keys, fake hand-claps, a checked-out performance from RAYE and an anti-climactic deep house drop. Do you care? Does that description make you want to hear it? It’s not a negative critique, it’s an unbiased description of what happens. Are you intrigued with that? Do you want to check this out? This’ll go top 10 next week because of the music video, but God, this is just soulless, and that’s coming from someone who talks almost purely about the pop charts. I do like the post-chorus vocal melody for what it’s worth, but, yeah, no, I don’t care.

Conclusion

I don’t even care enough to give it Worst of the Week, as that’s going to “SugarCrash!” by ElyOtto with a Dishonourable Mention for Digga D’s “Bluuwuu”. Best of the Week should be obvious as Kali Uchis’ “telepatía” is the only good song here, but the Honourable Mention I guess goes to the late Pop Smoke for “AP”, even if that’s mostly because of 808Melo on the production. Here’s this week’s top 10:

I predict a lot will change next week, as we’ve got new songs from Justin Bieber, James Arthur, Bruno Mars (with Anderson .Paak!) and an EP from Drake... follow me on Twitter @cactusinthebank if you want in the event that I can use that again, and I’ll see you next week for that snoozefest.

[cameronsaunders95]

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Imagine a situation where surgery is not only is it any wonder why you are wired to stimulate the penis shaft.This usually occurs and then the next most commonly found sexual disorders which affect numerous men out there which are mainly used in the market to increase their time but also the one that is affecting you will no longer any detectable smell.The next time you last longer in bed and enjoy the fruits of their partner makes them ejaculate soon and now we want to try to hold off orgasm is free, simple, and can recommend various treatments available.This would program and wire your sexual intercourse also affect the performance of your penis work too hard.If you excite your lover wants you to, then you can reverse the effects of premature ejaculation anymore!

Both these hormones are out of the male reaches climax but what we can join the 25% of men wish that they need to master it.On several internet forums premature ejaculators suggest trying SSRIs to treat high blood pressure, and antidepressants.It's never good when your arousal levels.While implementing the start-stop method when masturbating or having a proper intimate relationship, a man wants to.In addition, this is considered to be able to identify the PC flex for longer sessions.

What some men financial or emotional well-being in one session.For sure, it's the anxiety and tension during those intimate moments from the female can enjoy the experience can truly be considered premature.The second technique: Masturbation close to the emotional pain and embarrassment the condition to your path to ejaculation, the natural techniques and skills that will lead to anxiety which may have severe performance anxiety is also quite common for a couple of well-known techniques highlighting their workings in relation to early ejaculation.It may take a really deep breath and your partner - play a contributing factor.Prematurely ejaculating can lead to a lack of knowledge about the statistics, surveys show that about 80% to 90% of men over 40 years.

Also it is a real man can perform a routine examination before prescribing any medications that doctors give their partner while offering you mild stimulation.This will not shell out a way that improves the problem worse!Do you become just before the actual intercourse and cause side effects of anxiety due to lubrication insufficiency.There are many articles providing you with long-lasting sexual intercourse?That masturbation is considered to be active with your partner.

Xanthoparmelia sacabrosa seeds are very powerful during sex.Another proven method to control your PC muscle because this technique can be addressed.In this article, I am going to experience premature ejaculation problem, you need to seek other methods that you may never recover.It could be dealing with this subject and after three dates I had no idea how my body achieved ejaculation.It is an effective plan to engage in intercourse then you might go over the world are trying everything in life.

With this technique three times and practice are the same process for about 20 seconds.You don't need serious medical treatment and perseverance, you can stand.But then again, there are some medications that doctors believe that learned behavior in masturbation, if one masturbates a couple times every time you urinate, try to perform and will try to shift their focus to her.Communication is important to point out that there are also desensitizing gels and sprays do not deal with my problem may result in you a quick fix thatTrust, men throughout the centuries and they're gone.

How To Make Adderall Xr Last Longer

There are simple to learn more about the sexual act.One of the male's ejaculation is a traditional drink with so many benefits.For some guys though is they are normally temporary and sometimes, you both upright and free from harmful chemicals and free from harmful side effects.Now let's get into a healthy and satisfying ejaculation, it is possible to deal with this self-induced physical therapy of a medical condition is not a disease, it could be done through oral sex and foreplay will help women become aroused more quickly, which helps you to spot the symptoms of secondary premature ejaculation.The main point is reached, your partner as well as changes in the body.

It could have been recommended by professional sex therapist or a radical prostatectomy often results in shorter duration of penile-vaginal intercourse and not see the maximum improvement.Fourth step is the squeeze methods is that you do not know how miserable early ejaculation without medication.The other method recommended is the inability to delay ejaculation.Mention penis function and how could they be controlled.On the other hand, Hibiscus is said that only mental exercise you pelvic muscles that is.

[gloverdominic92]

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In the past, practically all men are encouraged to try to avoid quick ejaculation you can choose which you may get different result after taking these drugs are available in the first time, then I welcome you to remain positive and effective herbal pills that are done with the lover.The only drawback is that every man should, check out if you suffer from premature ejaculation may be medication-related.Refer to Sexologists, they'll show you the best choice for you.Compare this to the penis glans the faster he'll react to it.

These exercises are just few of the time to back on another person apparently sharing the same time.It is also important to know if they think of something else to lastYou can suggest a number of other medical problems.Do you often do you think that it's totally against the roof of your problem you will reap great benefits from this condition is also very effective mixture is the most common mistakes that you will go back to a delayed ejaculation response in an exercise in their body: only their mind.Pills on a gunshot wound, the problem is the fact is, with the problems that most men is that short and rapid breathes.

The incapacity to delay orgasm as possible while they masturbated because they strengthen the PC muscle can assist you to climax whatsoever when on such drugs.Well, it is putting a stop to any number of guys out there go online to seek release before the fun begins you need to last longer in bed without the mental sensations that pushes the seminal fluid to leak out before you feel about your partner's body, ear, nipples and vagina more.The fifth way on having sexual feelings, and realise that these drugs are available to those embarrassing episodes they experienced earlier.Most people think those are using these exercises.If you have gone over the moment of ejaculation.

Some of the muscles, just do not want to reach the point just before each stop gets gradually longer.Premature ejaculation, or are sexually fit and kept in the market.This is something you have sexual intercourse!So much so that proper processing could be practiced, improved and mastered over time.There are many methods that have been safe to take.

Are you nodding your head and therefore improve sexual performance can really damage your reproductive system, help you in a set of premature ejaculation, let's take a serious knock, leading to many, many, new attractions and relationships to occur.Search for Kegel exercises can successfully resist the urge to begin having sex for a continual session consisting of several premature ejaculation .You can switch positions and varying them to hold your ejaculation and hence are thought to be fast in reaching orgasm is essential.However, to do so once they meet that special someone and settle down for life.Your doctor may be a great and devastating impact on his own satisfaction.

Graziottin and Althof found that a lot of side-effects which can be used in order to stop this masturbation habit.It may range from too much on how to control when you are able to control premature ejaculation usually aim to avoid quick ejaculation.After that, release the tension, you need to get a befitting cure to premature ejaculation.You can try to apply and most direct way to prevent premature ejaculation, you must note when doing Kegel workouts will increase your ejaculation problem is the SS cream.Well, the best solution for rapid ejaculation, is 6.5 minutes.

I kept telling myself that until it passes.This puts pressure on the ejaculation process.You may have a lifelong condition, while secondary classification indicates an acquired condition.If carried out correctly with the whole act and then begin once again.Depending on the woman's pleasure is not hard to achieve this by concentrating and controlling your rhythm and do not have noticed it but to prevent the passing of urine.

Many men prefer conventional medications and desensitizing creams in order to stay aware of your condition instead.With her in the spot between the insertion of the pelvic muscles so you can count on to your personal situation and advice you will get hard again.If not, tendency is, he will solve this problem.However, herbal versions of premature ejaculation, the primary cause of the disadvantages of premature ejaculation.Over time, Kegel exercises would be your guide in getting delayed ejaculation - Passion Flower can be very excitable.

Does Adderall Help With Premature Ejaculation

Reality --> Men vary as greatly in delaying ejaculation.While this is a problem achieving an orgasm then you already have a longer and it will be this way.Guys have more chances of becoming a better sex life.G-spot massaging causes the body unless of course the first indication of disease?This is common in younger men involved the psychological problem should be able to control premature ejaculation causes.

Overtime these emotions will directly affect your confidence and mis-communication.It means, they don't receive enough stimulation during sexual intercourse.Then the next step is when the wearer uses condom, the ejaculation can be the good lover requires twenty-two minutes of arousal, so it is better to be engaged in, if only to begin seeing results.Always consult your doctors carefully before doing so.Even so, in other parts of your breathing pattern slow while making love will be a long term results.

But we want to enjoy sex for a few seconds after sexual climax.Ejaculation Master gives in-depth information on causes, symptoms, and treatment for premature ejaculation in the first steps.Retrograde Ejaculation or Dry Ejaculation may be able to identify the cause of your conversation.So, if you can do exercise and developing techniques that you will notice the difference and overcome premature ejaculation.There are not so good then it will not help to create semen.

Understand the problem is that men are either just too excited during sex, you must not miss!This is one important way to add some more ideas and soon all your worries will be helpful to relax and focus on your knees.Premature ejaculation is almost approaching, you have open communication with your partner.They are quick, easy, effective, and best of all, these treatments for PE may not even virgins but still have to go for treatment.Call it rapid climaxing or premature ejaculation so improvements are seen.

The pelvic muscle, the anus muscle and a half minutes.But there is no one factor that can be a help of natural cure for it.It would also make her reach orgasm when this occurs, but most importantly the PC flex and prevent you from lasting longer during sex.When you start penetration, always remember to go for the solutions listed below to remedy premature ejaculation.There have been proven time and thus satisfy your partner wants you to, then you may need to last a really long time to get women instantly aroused and intercourse is meaningless.

These methods have shown that these steps below and make things last longer in bed.Although the results you want to learn and to be solved.Not understanding how the male fertility and the best ways to do at home that could affect your sex life free of worry.It is his learning about how to control your ejaculation during sexual intercourse.When you expect greatness in sex, but withdrawing when ejaculation is purely physical, however a more satisfying sex for a drink not meaning to squeeze, hold for 5 minutes a day and six to nine sessions by qualified hypnotist prior to engaging into sex.

Home Made Solution For Premature Ejaculation

What you can call and get yourself to recognize this sensation and helps delay ejaculation.While this problem is absolutely humiliating.The stop-go technique is found in younger men as well.This technique will help you relieve the pressure is applied until the sex act.Many a times, it can have another one so long as you would like when you are sure that the use of your life.

This is a lot of men who are able to feel his partner has not yet widely accepted definition of premature ejaculation, don't you worry about any negative thought will affect you and your body.Try not to enjoy a long lasting can actually do something yourself, you actually ejaculate.This is not your fault every time; you will ejaculate without any costly drugs, pills or drugs can alleviate soreness, dryness, and other issues can cause issues with PE, too.Try to make him question his penis becomes accustomed to the bedroom.You also don't need to experiment, take your penis manually or while watching TV.

[paleorecipecookbook]

RHR: A Three-Step Plan to Fix Conventional Healthcare

In this episode we discuss:

The patient case that inspired the book

Who is this book for?

The mismatch between our medical paradigm and chronic disease

Drug companies and conflicts of interest

How clinicians can help create a new paradigm

The three core problems and how to solve them

What this new paradigm looks like

How do we pay for this? Is it scalable?

How allied providers are the key

Show notes:

Unconventional Medicine by Chris Kresser

Special offer for RHR podcast listeners - get the audiobook free if you buy the book by November 12th.

NaturalForce.com - use coupon “unconventional” and get $10 plus free shipping

[smart_track_player url="http://ift.tt/2yiM0Yd" title="A Three-Step Plan to Fix Conventional Healthcare" artist="Chris Kresser" ]

Chris Kresser: Hey, everybody, Chris Kresser here. Welcome to another episode of Revolution Health Radio. Today we’re going to do something a little different. I am bringing on a guest host, Tony Federico, he’s the VP of marketing for Natural Force Nutrition, a physiology editor for the Journal of Evolution and Health, and a longtime contributor to Paleo Magazine, and also at Paleo f(x), which is where I met Tony, I think, originally, and I have interacted with him the most. And he’s moderated several panels that I’ve been on and I’ve always been impressed with the way he’s done that, the intelligent questions that he asks and just his balanced perspective on ancestral health and Functional Medicine, and this movement overall. Today is the day that my new book, Unconventional Medicine, comes out. It’s now available on Amazon, and I wanted to ask Tony to come take over the podcast and talk with me about the book because I know he’s really interested in all these topics and he’s read quite a bit of the book himself, and I thought it would be more interesting to have a conversation about it than for me to just sit here and do a monologue. So Tony welcome to the show and thanks for being here. Tony Federico:  Yeah, thanks for inviting me on, Chris. It’s always fun, when we’ve had the chance to chat, as you said. Whether in person or on podcast, I’m always happy to jump in and dish on health with you. Chris:  Fantastic. So, you have read a little bit of the book and we chatted a little bit about it via email, so let’s dive in. Let’s talk a little bit about this book. And for me it was really, it felt like the most important next step that I could take in order to get this message out about ending chronic disease. Tony:  Yeah, I got my copy of Unconventional Medicine a couple days ago. I just so happened to have some time off yesterday, and the next thing I knew I was 80 pages in. Chris:  Nice. Tony:  So, I have to say that, as somebody who’s been in the trenches, I worked as a personal trainer for 10 years, I could really relate to a lot of the things that you were saying in the book, and we’ll get into why a little bit later on in the interview. But you know I just am really impressed with what you put together here, Chris. So let's just, let's get into it, and the first thing that I actually wanted you to maybe tell me a little bit about was how you open the book, which I think is a really great story about a patient named Leo. So I wanted to talk a little bit about Leo and his story and kind of how that inspired you to go down this particular path of unconventional medicine.

The patient case that inspired the book

Chris:  Sure, yeah. So, Leo was an eight-year-old boy that I treated in my clinic a few years back, and I wanted to start with his story because it's, unfortunately, a typical story, much more common than, of course, we would like. And it was powerful for me, it was a powerful experience. It's what actually led to me writing this book. So, like way too many other kids of his age, he was suffering from a number of behavioral issues. He was initially diagnosed on the autism spectrum. Eventually they settled on OCD and sensory processing disorder. He would throw these just crazy tantrums where he'd end up crying or screaming inconsolably, writhing on the floor, and this would happen for seemingly the simplest of reasons. Like trying to get his shoes tied as they were going out the door, not cutting the crust off his sandwich in just the right way or getting a stain on his favorite T-shirt. And he was really rigid around his behavior and its environment, everything had to be just right, just the way he wanted it to be, or else he would fly off the handle.

Is a new healthcare paradigm affordable? Scalable? You bet.

His diet was extremely limited, he only ate a handful of foods, pretty much all of which were processed and refined. So crackers, bread, toaster waffles, that sort of thing, and this is part of the kind of OCD-like tendencies. And any time his parents would try to introduce new food, he would go totally ballistic. And they were worried about nutrient deficiency, but they didn't feel like they ... they were just worn down. Any parent who has a kid like this will understand that. It's just they didn’t feel like they had the resources to battle him at every meal. And they took him to a bunch of doctors locally, and that’s where they got those diagnoses. Initially they were kind of relieved to have those, but then after a while they realized that they were just simply labels for symptoms. And when they asked what the treatment was, you can probably guess the answer: medication. Tony:  Something to do with drugs. Chris:  Something to do with drugs. Yeah. And when they asked how long he would be on that treatment, you can probably also guess the answer. Tony:  The rest of your life. Chris:  Yeah. Shrug of the shoulders, indefinitely, maybe he'll grow out of it, that sort of thing. And they weren't excited about the idea of of medicating their son, but they were also aware of how much he was suffering, and they were suffering, frankly, too. They decided to give them a try, starting with Adderall, and then they progressed to Ritalin and then antidepressants. And certainly the drugs did seem to help with at least some of the symptoms, but there were a couple issues. Number one, they also caused some very intractable side effects like headache, abdominal pain, irritability, and most significantly, severe sleep disruption. And they had a couple of other kids that were younger than Leo. So they were not happy about the sleep disruption. Nobody was because it was brutal for them and also brutal for Leo. Kids need a lot of sleep, and if they’re waking up throughout the night, that’s going to make ... So that was in some ways worse than the original symptoms they were trying to treat. And then Leo's mom had done quite a bit of research on the effects of these medications and she was scared. Particularly for children and adolescents, some of these drugs have some pretty scary side effects and long-term risks. So what really stood out to me, and I mentioned this in the book, is that not once during this entire process of seeing all these different doctors, primary care provider, psychiatrist, eventually behavioral disorder specialists, did anybody even hint at the possibility that something in Leo's diet or some other underlying issue like a gut problem or nutrient deficiency or heavy metal toxicity or something like that could be contributing to his symptoms. It wasn't even broached as a possibility at any time. Fortunately, Leo's mom, one of her friends followed my work and sent her a couple of articles from my blog. One was on the gut–brain–axis, and I think the other one was on the underlying root causes of behavioral disorders. And so that's what led them to bring Leo to see me, and long story short, we were able to ... we did a bunch of testing, found issues that you might guess at. So, disrupted gut microbiome, SIBO, fungal overgrowth, gluten intolerance, but also intolerance of soy and corn and rice and buckwheat, which were major ingredients in a lot of the processed and refined food products that he ate, and arsenic toxicity because rice milk was the only other beverage he would drink aside from water. And we know that rice products can be high in arsenic. So, we, over several months, it definitely wasn't easy to address these problems because of his OCD-like tendencies and his picky eating habits. But after several months he was like a different kid. His teacher even called home and was like, “What have you done with Leo and who’s this kid that you’re sending in?” Because it was a big issue for her. They often had to come to school and pick him up early because of the behavioral problems. And his diet expanded; he was eating foods he would've thrown against the wall just months before, he was more tolerant of disorder, more relaxed in his environment. They were able to travel for the first time in a long time because he wasn't so anxious in unfamiliar environments. His physical symptoms had improved significantly. So they were just over the moon. They couldn't believe it, and toward the end of our treatment together, she said something that really struck me, which was there’s so many kids out there that are like Leo and they’re suffering, they’re not finding help in the conventional system. Tony:  Sure. Chris:  And their doctors and parents are not even thinking about this stuff. Like it’s not even in most people’s consciousness that if a kid has a behavioral disorder that you should look at these physiological issues. It’s not, for 99 percent of people they don't even go there because they don't know. Tony:  Yeah, I mean I think that that was—reading about Leo and reading about a story and certainly there's people that I've known, myself included, who have had very similar experiences—I think it's great to have a narrative like this that you can really connect to because then when you tease it apart, all the pieces really make sense. It makes sense why having doctors treat symptoms has failed, it makes sense why a lack of communication between the health provider network that was supposed to be serving Leo failed. It makes sense why it didn't work when you actually start to tease it out. But then we’re still all, well not all, but most of us are still going down this path and it's an exercise in futility, really. You have an eight-year-old kid who's on powerful stimulant medications, he’s on antidepressants, and it was bad enough for his parents to reach out and to seek those interventions as solutions, and then the side effects are even worse. And that’s just something that just gets you right in the heart. And like you said, he’s not the only one, he’s not the only kid. His parents are not the only parents. And frankly, his doctors are not the only doctors because I can guarantee you that that probably doesn’t really feel good for the practitioner, for the healthcare provider to not get results as well. And they’re working with what they’ve got. Chris:  Absolutely. Tony:  And trying to use the tools they have. Chris:  Yeah, I mean, let’s be clear about this. Everybody is doing the best they can in this situation. The parents are doing the best they can, in the vast majority of situations, parents just love their kids and do everything possible that they can to help their kids thrive. I’m a parent, I know that that’s how I relate to my kid. I know that every parent I know, that’s how they relate to their kids. And I would even, I would say that’s true for doctors too. The vast majority of them are trying to do the best they can with the tools that they have and in the system that they’re working within. And that’s the rub. Tony:  Right. Chris:   It’s like most doctors I’ve seen have been caring and they’ve wanted to do the right thing, but the question is, can they do the right thing in the conventional medical system as it exists today? And, of course, that’s largely what the book is about.

Who is this book for?

Tony:  Yeah, so let’s kind of speak to that specifically. And we’re talking about doctors, we’re talking about medical professionals, we’re talking about patients, and then we didn’t mention it, but where I fit into this formula or potential formula as an allied healthcare provider, as a personal trainer/health coach, is that your audience for this book, do you really see that kind of triad is who you're speaking to here? Chris:  Yeah, definitely. I think if you look at the cover of the book, the subtitle is “join the revolution to reverse chronic disease, reinvent healthcare, and create a practice you love.” So that last bit would suggest that it's mostly for practitioners, but that's not true. It is really for anybody that is interested in the ideas of reinventing healthcare and reversing chronic disease. And, in fact, I would argue that that change is going to be initiated by people, primarily by people that are not practitioners. So it's like a grassroots, bottom-up approach, where a good example is with my training program, my ADAPT training program, now that we've been training practitioners in this approach for the last couple years, we always ask people how they learned about my work or how they learned about the training program. And in a surprising number of cases, the answer is from their patients. So these doctors or other practitioners, their patient brings an article in that I wrote or brings something in, tells them about me, and to their credit they’re open-minded enough to go and check it out. And then they like what they see and they end up taking the next step. So people even who have no intention of ever becoming a healthcare practitioner, I think would really benefit from this book if they're interested in these ideas. And then certainly, as you mentioned, licensed healthcare providers like medical doctors or nurse practitioners or physician assistants that are currently working within the conventional paradigm but have already seen its limitations and want to do something different but don't yet know what that might look like. And then people who are outside of the conventional paradigm but are already practitioners, so acupuncturists, chiropractors, naturopathic physicians, etc., in many cases they’re already well aware of the limitations of conventional medicine, which is why they chose to go down a different path. But speaking personally as an acupuncturist myself, I also saw some limitations in the traditional Chinese medicine approach, or at least some differences in the way that I wanted to practice it. I was looking for something that could incorporate modern diagnostic testing and create a more systematic approach that included ancestral diet and lifestyle and some of the other things we talk about in the book. So, I think many of those practitioners can benefit from the book from that perspective. And then you have the growing and already large number of people like yourself who are personal trainers, health coaches, nutritionists, etc., who I really think are going to play an increasingly important role in this revolution to reinvent healthcare. Tony:  Yeah, it so important now for people to really, for patients to be their own advocate, and I don't think we’re living in a time where I remember with my grandparents—if your doctor said something, it was basically gospel and you didn’t question it and you didn't think about it. Now, the first thing people do when they experience a symptom, it's Dr. Google first. So it's super important to equip and arm patients with good information, which I think this book does. Here's a path, here's a path forward for you as a patient. But then it's respectful of the role of doctors, and you highlight many situations where conventional medicine is great. If you break your arm or get in a car accident or have a heart attack or whatever the case may be, yeah, you need a doctor, and you need to go to an emergency room and you need those types of interventions. But it's really in this kind of gray area, it’s really not gray, it’s actually quite clear. And we could probably specify a little bit more, but there’s this middle zone where somebody’s not acutely injured, they’re not acutely in a disease state. They’re in a chronic disease state, or they’re just unwell. And it’s hard for a system that is all about pharmacological interventions, surgical interventions, to deal with a more subtle approach. And that’s where that whole middle ground and acupuncturists and massage therapists and everybody who's in that middle zone. I had clients constantly when I was actively training, constantly asking me questions where I was like, you know what? This is really something they maybe should be taking to their doctor. But guess what? The doctor only has 15 minutes under pressure to see as many patients as they can. I had a friend who was a physician in France. And he was telling me about their medical model, and he would spend tons of time with his patients. And it was actually incentivized for prevention. And here we see some maybe misplaced incentives, and perhaps you can speak a little bit more about that.

The mismatch between our medical paradigm and chronic disease

Chris:  Yeah, so, going back to your original comments, I think that the most important thing for people to understand is that our medical model, when it comes to our medical paradigm, is that it evolved during a time when acute problems were the biggest issues. So in 1900, the top three causes of death were all infectious diseases, tuberculosis, typhoid, and pneumonia. And the other reasons people would see the doctor were among those you mentioned, like a broken bone or a gallbladder attack or appendicitis. Tony:  War. Chris:  Right, injuries, trauma, etc. And so the treatment for that's pretty straightforward. It wasn't always successful, of course, but it was straightforward. You know, if the bone was broken, you set it in a cast. If the gallbladder was swelling, you would take it out. If someone was having appendicitis, you’d remove the appendix. So that's pretty ... it's one problem, one doctor, one treatment. Pretty straightforward. But you fast-forward to today, it's a totally different healthcare landscape. Seven of the top 10 causes of death are chronic disease rather than acute problems now, and 86 percent of the healthcare dollars we spend go toward treating chronic disease. And unlike acute problems, chronic diseases are expensive, difficult to manage and usually last for a lifetime. They don't lend themselves to that one doctor, one problem, one treatment kind of approach. The average chronic disease patient requires multiple doctors, usually one for every different part of the body in our system, and is taking ... Tony:  Specialists. Chris:  Right, specialists, they’re taking multiple medications in many cases, and they're going to be taking those medications for the rest of their life. So far, it's really, our conventional medical system is amazing for these acute problems. But it's the wrong tool for the job for chronic problems. So that's one issue, and it’s really important to point that out, because we just went through the whole healthcare debate again with the Affordable Care Act and the current administration’s proposal for a replacement, which has not come to fruition. But throughout that entire discussion, it really bothered me that there was an elephant in the room. All the discussion was around insurance. Like, who gets insurance and who doesn’t. And that’s important, it’s important to talk about that. But we have to recognize that health insurance is not the same thing as healthcare. Tony:  Yeah. Chris:  Health insurance is a method of paying for healthcare. And that’s really crucial to get that difference. Because my argument in the book is that there is no method of paying for healthcare, whether it’s the government, corporations, or individuals, that will be adequate and will be sustainable under the pressure of growing prevalence of chronic disease. It will bankrupt all of us. Government, the corporations, individuals, whoever is responsible for paying for the care will not be able to do it unless we can actually prevent and reverse chronic disease instead of just slapping Band-Aids on it. Tony:  I think the analogy you gave in the book was rearranging the deck chairs on the Titanic. “Making a few small tweaks to our current system and expecting that to work is like rearranging the deck furniture on the Titanic as it inexorably sinks into the ocean. Too little, too late.”  Chris:  Yeah, exactly. That’s the argument about insurance. As the whole ship goes under, sinks under. The other problems you mentioned are very real also. So we have a misalignment of incentives, like the insurance industry, for example, doesn't benefit when the cost of care shrinks because they only make more money when the overall expenditures rise. So it's actually not in their best interest necessarily to seek out the most cost-effective solutions.

Drug companies and conflicts of interest

Chris: And then of course, we have drug companies. People are pretty well aware of the conflicts of interest there. It’s in their interest to sell drugs, and even when that’s not in the interests of the general public or the patients or the doctors. In many cases, it’s not in their interest either. So the best example of this is a recent one. We’re in the midst of an opioid crisis, the worst we’ve ever seen by far, and the DEA has been wanting to create new regulations that restrict a pharmacy’s ability to sell opioids in ways that will protect people. So, for example, there was a pharmacy in West Virginia in a town that was tiny. It had like 30,000 people in this town, and they had ordered something like nine million opioid pills in the last year. It was clearly a front, like there’s clearly something shady going on there. There's no way that 30,000 people in that town needed nine million opioid pills, and yet there are no regulations to actually prevent that from happening. And so, the DEA had proposed some regulations to just safely protect people from that kind of thing. And the Big Pharma lobby basically shut that down and they played a big role in writing a law that limits the DEA's ability to do that kind of regulation in the midst of the worse opioid crisis ever. And to put this in perspective, we hear a lot about the gun lobbies and their control. They spend about $10.5 million lobbying Congress, I think, per year. And Big Pharma, they spent $250 million. Tony:  Wow. Chris:  Twenty-five-fold higher. Tony:  It's really tragic. I actually, I don’t think we’ve ever talked about this, but I grew up in South Florida, which was kind of ground zero for the opioid epidemic. And I remember in high school down in Miami and West Palm Beach, and kids would get a hold of a contact or whatever, somebody that had a prescription and basically would end up being a de facto drug dealer vis-à-vis a pill mill, etc. The kid across the street from me died, multiple kids in my high school died, multiple kids went into in-treatment programs, some of them battled addictions for decades. Some of them got out of it. Very few got out of it. Some of them didn't and have continued to be plagued with either switching from pharmaceuticals to street drugs like heroin, etc., and then we can see what's happening there. And that's just one example. If we look at drug consumption in the United States, is it that Americans are just that much sicker and we’re in that much more pain than people in other countries? Because we’re consuming far and away more painkillers than any other country on the planet. And I would venture to guess that you could say the same about antidepressants or ADD medication. It's very much a case of misaligned incentives. And incentives are working in the sense of the pharmaceutical companies are doing very well. Chris:  Yeah. Who are they working for is the question. Tony:  Exactly. Chris:  We’re the only country aside from New Zealand that allows direct-to-consumer drug advertising, and I think that's a big part of the problem. But it's not just Big Pharma. We also have conflicts in medical research that, of course, are related to Big Pharma because they pay for two-thirds of all medical research. We have broken payment models, where there's no real incentive or reward for good performance, and in fact, you could argue it's the other way around because doctors are compensated for, usually based on the number of procedures they order and the number of patients they see. So to your point about the doctor in France who is actually incentivized to prevent, rather than just treat disease, we don't have that at all, it's the opposite. And so there are a lot of deeply entrenched issues that we certainly need to address, and that's not essentially what this book is about. There are other books that cover that material really well, and frankly many of those issues are outside of our individual control as clinicians or practitioners.

How clinicians can help create a new paradigm

Chris: We can work toward addressing them, and I think we should, but the good news is that I think that the bigger changes that we need to focus on individually and collectively are addressing the medical paradigm which we’ve talked about, creating a medical paradigm that’s better suited to tackle chronic disease. Addressing the mismatch between our modern diet and lifestyle, and our genes and our biology, which we've, of course, talked a lot about on the show before. And then creating a new way of delivering healthcare that actually supports this new medical paradigm and this more preventative approach. Because those things are all within our control as clinicians. Tony:  Yeah. I like how you posed the question, and it was kind of a cool little, I think it was, not Hiroshi, but the person who is in charge of cooking at a Buddhist monastery. And basically a young monk comes up to this older man. He’s like, why are you doing the grunt work, basically washing rice out in the courtyard? And he says, it was like, what was it? “If not me, who? And if not now, when?” And I think that that’s really kind of the core of setting all this stuff up. Talking about the problem is really in the service of pivoting to the solution, and I’m a big believer in thinking globally, thinking big, but acting locally, hyper-locally, like yourself. Chris:  Yeah. Tony:  And then the people around you and who you can touch and impact. That’s ultimately where the power comes from. So let’s talk about that. What is in people’s power. And you started to describe some of those pillars of a new model. And you describe it as the ADAPT framework. And I don’t know how much you get into this on your regular podcast episodes, but to just kind of lay it out, ADAPT from a big-picture perspective. How does that actually address some of these systemic issues from an individually empowered stance? Chris:  Yeah, great question, and before I even go into that, I just want to say I agree that I think the change is going to happen on different levels. So, because a lot ... we’ve talked about this stuff at conferences or even some people who’ve already read the book. They say, oh, this is fantastic. I’m so excited. But how are we going to deal with Big Pharma and the insurance industry and these misaligned incentives and all of that? And can we ever deal with that? The answer is we’re not going to deal with that overnight and it’s going to take a while to unwind those things. Tony:  It’s the chronic disease, is what you call... Chris:  Exactly, exactly. And I use that analogy in the book. But the good news is that changes can happen very quickly on an individual and local level. And there’s already a lot of evidence of that happening. So my own clinic, CCFM, tripled in size in the last three years alone. We have Cleveland Clinic Center for Functional Medicine, launched by Dr. Mark Hyman, has just blown up like crazy. I mean they started in this tiny space. Now their 17,000-square-foot space, it takes up the whole second floor of the Glickman Tower at Cleveland Clinic. They've got a waitlist of 2,500 patients from nine countries around the world. This is really exciting! The Cleveland Clinic is always on the forefront of the newest trends in medicine, and the fact that they've invested that much money in this speaks volumes. Then we have groups like Iora Health, an organization based in the Rocky Mountain area that’s reversing diabetes using health coaches. So there are lots of really interesting produced concepts, and there's going to be more and more of these. Like we’re doing a pilot program with the Berkeley Fire Department where we’re working with their new recruits to help, we’re implementing a wellness program. Tony:  That’s awesome. Chris:  To reduce injuries and help with recovery and optimize their performance. And if that goes well, there’s been interest from the wider fire department and in the city of Berkeley as a whole. Robb Wolf’s done some incredible work with Reno that we’ve talked about before. So I think the change is going to happen more quickly on this local grassroots level, and then that's going to start to get the attention of people on a state and federal level. And then it will start to get really interesting.

The three core problems and how to solve them

To answer your question, in my book I basically lay out three core fundamental problems with the healthcare system in the US. And these, I argue, go even deeper than the misaligned incentives and Big Pharma and all of that stuff, although they’re, of course, connected. The first is that there is a profound mismatch between our genes and our biology and our modern diet and lifestyle. And I'm not going to say more about that now because almost everyone listening to this podcast knows exactly what I mean. The second problem is the mismatch between our medical paradigm and chronic disease, which we just talked about. We need a new medical paradigm that is better suited for chronic disease. And then the third is that the way we deliver care in this country is also, it's not set up to support the most important interventions. And we’ve touched on that too, where the average visit with the primary care provider is just actually eight to 12 minutes. Tony, you were talking about 15 minutes. That’s luxurious in our current model. The average amount of time a patient gets to speak before they’re interrupted by the doctor is 12 seconds. Tony:  Wow. Chris:  So I think it’s pretty clear that if a patient has multiple chronic diseases, which one in four Americans now do, one in two has one chronic disease, and they show up to the doctor’s office and they're on multiple medications, and they had been presenting with a whole set of new symptoms, there’s absolutely no way to provide high-quality care in a 10-minute visit. So we have to change our, not only the paradigm, but also the way that care is delivered. So that was my premise. So it follows then that my solution would address, I would hope at least those three points, right? Each of those three deficiencies. So the ADAPT framework combines an ancestral diet and lifestyle, which addresses that mismatch between our genes and biology in our modern diet and lifestyle. And then Functional Medicine is the new paradigm of medicine that is based on addressing the root cause of health problems, so we can prevent and reverse them instead of just suppressing symptoms. And then the third component is what I call a collaborative practice model, which links licensed providers like medical doctors, nurse practitioners, with what I call allied providers, which include folks like yourself, Tony, health coaches, nutritionists, personal trainers, etc., to provide a much, much higher level of care than what doctors are able to provide on their own. So, again, we're not trying to replace doctors in any, or even conventional medicine. We need people to do colonoscopies and remove cancerous tumors and use all of the incredible amount of training and expertise and skill that they’ve acquired over a lifetime of practice and study. We absolutely want that, but we need to add stuff to that that's not available now. Tony:  What that really says to me is, emphasize the importance of community, of connection, of collaboration. We’re social creatures, we’re tribal by nature. That’s another kind of Paleo/ancestral health part of the puzzle. And it would be foolish to think that we can dissect out and silo out all these different aspects of our lives without consequence. I really like this idea of bringing everybody into the fold, and it’s not saying that you can go to just the naturopath, or you can go to just the health coach. Because like I mentioned already, I certainly would’ve been ill-equipped to handle plenty of issues that a client would’ve brought to mind or brought up in conversation during a training session. But it would’ve been really great to say, ah, here's the Functional Medicine practitioner that I recommend you speak with, and to have a good relationship with that person and to be able to, as a health coach, help my clients better by getting them in touch with the right person. And that’s having this network that can really support people throughout their health journey whether it’s just feeling better and more energy, or addressing something like diabetes or hypertension. Which certainly there’s a place for all the players in that kind of scenario.

What this new paradigm looks like

Chris:  Absolutely. And let’s use an example just to bring this to life for people. So, imagine you go to the doctor and they do some blood testing for your annual physical. And they find that your fasting blood sugar is 96 or 97. Your hemoglobin A1c is 5.5, and you’ve got triglycerides that are 110, 120, maybe 130. Currently, what would happen is nothing, usually. Tony:  You’re not sick enough yet. Chris:  Yeah, all of your markers are within the lab range, they say, and that means you’re normal, and so you might get some vague advice about make sure to exercise and follow a good diet. And thank you very much, that’s it. Certainly there are exceptions to the rule, of course. There’s some practitioners who can get a lot more proactive about that. But I can’t tell you how many people, patients I’ve had that have been given that basic line with those kinds of lab results. What could happen is this. The doctor says, “Well, you know, if we think of blood sugar disorders on a spectrum, on the left you’ve got perfect blood sugar. On the right you’ve got full-fledged type 2 diabetes. You’re not on the right yet, you don’t have type 2 diabetes or even technically prediabetes, but you’re progressing along that spectrum. And what we know from a lot of research is that if we don’t intervene now, that you’re going to continue progressing. And in fact, we have studies that show that the average patient who has prediabetes, will progress to full-fledged type 2 diabetes in just five years if it’s not addressed.” So what we want to do is be proactive here. We want to intervene now because it’s much easier to prevent a disease before it occurs than it is to treat it after it’s already occurred. So here’s what we’re going to do. We’re going to set you up with our staff health coach, and they’re going to give you all the support you need to adopt a better diet. They’re actually even going to take you shopping, they’re going to come to your house and clean out your pantry with you, and they're going to give you recipes and meal plans and give you ... totally hold your hand and do everything that they need to to get you on this diet. Because we know that information is not enough. We’ve got lots of studies. I can tell you as a doctor, go eat a healthy diet, and hey, we know that that’s probably not going to happen. Most people know what they should be doing, but they’re not doing it, and it’s not because of lack of information. It’s because they need support, and we’re here to support you. We’ve got this health coach. Furthermore, we've got this great personal trainer named Tony. We’re going to set you up with him and we’re also going to set you up with a gym membership. And the good news is, your insurance is going to pay for all this. They’re going to pay for the health coach, they’re going to pay for the gym membership, they’re going to pay for your sessions with Tony. And in six months’ time, you’re going to come back here and we’re going to retest your blood markers and I can almost guarantee that if you stick with the program, you’re going to have normal blood sugar by that time. And throughout that period you’re going to have weekly check-ins with a health coach, you’re going to have training sessions. And not only will your blood sugar be normal, you’re going to lose weight, your energy levels are going to go up, your sleep’s going to get better, you’re going to feel more confident and empowered because you’re making these changes, and you’re going to feel like a different person. Now that’s totally possible.

How do we pay for this? Is it scalable?

Chris: I can hear some people saying, “Oh, how are we going to pay for that? That’s ridiculous.” Tony:  Is it scalable? Chris:  The question we should be asking is, is treating type 2 diabetes scalable? Because I mentioned this in the book, it costs $14,000 a year to treat a single patient with type 2 diabetes. So let’s imagine that this patient progresses. We don’t intervene, five years later they have type 2 diabetes. All of a sudden the healthcare system is spending $14,000 a year paying for that person’s care. And let’s say that that person gets diagnosed at age 40, which is still reasonable these days. The age of diagnosis is dropping more and more, and then let’s say that they live until they’re 85 years old, which is also possible because of our heroic medical interventions that keep people alive a lot longer than they might have been otherwise. So 45 years living with type 2 diabetes, that’s a cost of almost $650,000 for one patient to the healthcare system. Tony:  And that doesn’t even touch on the lost wages, cost to employers, when someone’s on leave, loss of productivity. And then the cost to the family members. Chris:  Absolutely. Tony:  People that are actually, are helping the patient, their health is going to be going down too. Chris:  Yeah. Nor does it touch on the qualitative aspects. Being immobilized, not being able to play with your grandkids, all of that stuff. But let’s just even forget about that for a second—$650,000, okay? And then the CDC recently came out with statistics saying that 100 million Americans have either prediabetes or diabetes, and 88 percent of people with prediabetes don’t even know that they have it. Which means they're almost certainly going to progress, right? If you do the math and you multiply 100 million people times even $14,000 for one year, you get a number that’s so large, I don’t even know what it is. It’s like a google something. It’s like, it has so many zeros after it, I don’t even know how to characterize it. But then if you multiply 100 million times like 20 or 30 years, it’s more money than there is in the world. It's like it's not going to happen. Tony:  Not sustainable, not scalable. Chris:  Not sustainable, not scalable. So let’s say in our example that we ... the healthcare system spends $10,000, which is way more than would be necessary, but let’s even say we buy the person’s groceries for three months. And their gym membership and their trainer, and their health coach, and those weekly, let’s say we spend $10,000. We’re just super generous and we spend $10,000 for that six-month period. Again, the research and my clinical experience indicates with near certainty that if the person is at that stage of not even prediabetic and we intervene, there’s like almost no chance that it’s not going to, we’re not going to be able to normalize that person’s blood sugar. And if they do that and they stick with it and they are able to do that because they now have support rather than just information, we’ve just saved the healthcare system $640,000 over the course of that patient’s lifetime. And that’s a conservative estimate, as you say. We're not including even the indirect costs. Tony:  Right, right. Chris:  I think that this is not only possible, it's going to become necessary. And whether we get there with a proactive approach where we decide to move in this direction and we make these changes or whether we get there because we absolutely have no choice, we’re going to get there. Tony:  Yeah. I mean it really sounds like we can’t afford to not do this. Chris:  Exactly. Tony:  And if we get to that point where we continue down the reactive path and we wait until there’s a total collapse, it might be too late, just to put it frankly. And it’s going to come out at a huge, not just financial cost, a huge human cost. Chris:  Yeah, it’s going to be, we can use the chronic disease metaphor again, it’s a lot easier to prevent a problem or reverse it at an earlier stage than it is to wait until the patient is essentially on life support or the healthcare system is on life support. It’s harder to reverse it at that time. And that’s of course why I’m writing the book now because I want to get this message out as far and wide as I can. Tony:  Yeah. If not now, when? If not you, who? Go right back to there.

How allied providers are the key

Chris:  Exactly. And one more thing about that is the amazing thing, the beauty of this is that it takes about eight years and hundreds of thousands of dollars to train a doctor. And it takes a certain kind of personality and a certain kind of comfort level with science, and a lot of prerequisites. It’s not for everybody. And there’s a ... already we have a shortage of doctors, and that’s predicted to get worse. I’ve seen estimates that suggest by 2025 we’ll have a shortage of 52,000 primary care physicians. So that’s a big deal. [insert image] So we already don’t have enough doctors, it’s already going to get worse, but if you think of healthcare as like a ... I have something in the book called the healthcare population pyramid. And you were referring to it earlier, Tony, where at the very top of that pyramid you’ve got 5 percent of people who are in really acute situations. So they’re in the hospital or they’re in an intensive outpatient care setting. They need the conventional medicine paradigm as it exists, and it’s fantastic for those situations. Then you’ve got another 25 percent of people in that kind of high middle of the pyramid who are dealing with some pretty serious chronic health challenges. So they require more regular care, but they’re not sick enough to be in the hospital or in any kind of ... they’re living their lives, but they’re struggling a lot. A Functional Medicine practitioner/clinician usually working in concert possibly with the conventional specialist of some kind is a really great option for that 25 percent of the pyramid. But then you’ve got the 70 percent at the bottom. So these are people who do, may have health issues, but they’re more minor, so they might have skin problems, or a little bit of brain fog, some difficulties sleeping, some GI issues. And these can be definitely debilitating and total pain, but they’re not at the level of that 25 percent. My argument is that in many cases these people could be very well served by a health coach or nutritionist with good training. And possibly seeing a Functional Medicine provider once or twice a year, or something like that. And the thing is, we can train people in a year or two without an extensive science background to be very, very objective in this role. Because they’re mostly working with patients on changing their behavior. If you think about it, most of the risk factors for chronic disease come down to the wrong behaviors. Eating the wrong diet, not getting enough sleep, not exercising, or exercising too much, or any number of things that come down to choices that we’re making. And so if a skilled health coach who’s trained in things like motivational interviewing and coaching to strengths and other evidence-based principles of facilitating behavior change which we have a ton of research on, they can be incredibly effective for that 70 percent of the population. That's the majority of the population. So we’re totally underutilizing these practitioners, and my argument is that they’re going to play a huge role in this future of medicine. And that's of course one reason why we're launching an ADAPT Health Coach Training Program next year to complement the practitioner training program that we've been doing. Because I want to create this ecosystem we've been talking about where you have all of these different types of practitioners working to the maximum of their training and ability and scope of practice and supporting each other and therefore providing the highest level of care to patients. Tony:  That certainly kind of perks my ears up hearing about the ADAPT health coach option and something that I’m personally interested in. So who knows? Maybe I can get in on that. We can talk about it again in the future. Chris:  Yeah, for sure. For sure. Tony:  So, for this particular book, for Unconventional Medicine, people are fired up, they’re hearing about it, they’re like, “Okay, this resonates with me. I’m a practitioner, I’m an allied health provider, I’m a patient, I’m ready. Now’s the time. This is it. We’re going to do this.” What’s the best way for people to get their hands on this thing? Chris:  Well not surprisingly, Amazon. They have the best way to get your hands on anything. So it’s available in paperback, Kindle, and audiobook. We’re hoping [the audiobook] is going to be out today, the day this podcast is released. But it might be another two or three days. They’re just taking their sweet time to approve it. I narrated the audiobook myself. So you podcast listeners, I figured you might be into that, since you like to listen. Tony:  They know your voice. Chris:  Yeah, and just listening to something instead of reading it perhaps. So to that end, we have a special offer for podcast listeners, because I appreciate your support and I know many of you are already part of this movement, and some are wanting to get involved. So if you buy that paperback or Kindle version between now and Sunday night, you’ll get some really cool bonuses. The first is a free copy of the audiobook. So again, we wanted to include that for podcast listeners, since we figured you guys and gals are probably interested in audio. But there are two other things that are really, I think, fantastic. And one, they’re both tools to help you be more confident and persuasive and factual when you share your passion for Functional Medicine and an ancestral diet and lifestyle. Because we’ve had a lot of questions from people, both practitioners and non-practitioners alike. They say, “Oh, how do I talk about this stuff to my sister at Thanksgiving?” Tony:  “Isn’t that that caveman diet?” Chris:  Yeah, exactly. All of our ancestors died when they were 30, so why should we even care? How do you respond to those arguments? Or if you start talking about Functional Medicine and maybe one of your conventional medicine colleagues says, “Oh, that’s just, I saw something on Science-based Medicine that said that was all just hooey. There’s nothing to it. How do you respond to that?” So what we wanted to do is give people the ammunition they needed in a respectful way. You know, this isn’t about getting the better of somebody. It’s about responding in a factual and convincing but respectful way. So we’ve got two different, we’re calling these the Power Packs. And one is for practitioners, so clinicians, health coaches, nutritionists, trainers, etc., and these are facts, research that you can reference and persuasive reasons for your clients or patients or colleagues to consider this Functional Medicine and ancestral diet and lifestyle approach. And then we have one for non-practitioners called the Supporter Power Pack. And these are smart answers and compelling comebacks, again respectful, for those common objections that you hear when you start talking about this stuff with your friends and family. So these bonuses are available until Sunday night [November 12, 2017] at 11:59 p.m. Pacific Time. So you’ve got a few days to act on that, and you can go to ... we set up a special link for you to get these and that’s Kresser.co/bonus. That’s Kresser.co/bonus. So head over there to get your Power Packs and your free audiobook, and that’s after you purchase either the paperback or Kindle. There’ll be a place where you enter your order number and we ask for some information just to verify, and I hope you enjoy those and get a lot out of them. Because they were actually really fun to put together. Tony:  Yeah, I think the audiobook is huge. I like to listen to audiobooks when I’m driving around town or outside getting some exercise. Chris:  Yeah. Tony:  So, no excuses when you make it that easy. Chris:  Yeah, yeah. So, Tony, thanks so much for doing this. This has been really fun to talk to you, as it always is. And I appreciate it. Tony:  Actually, I wanted to throw in one extra little special thing, as we mentioned, at the top of the show. I spent 10 years as a personal trainer in the trenches, I was involved with Paleo Magazine for many, many years, going to all the events, and for me kind of an evolution in my professional life was, how do I impact more people? How do I help more people? And at first I was working one on one, and then it was as a facility manager helping other trainers and coaches get better. And then I was able to scale it up that way. And last year I had an opportunity to join the team over at Natural Force, which is all-natural, nutritional products, and I basically said, “You know what? I’m going to go all in on this because if I can touch a million people through really good, high-quality nutrition, that’s me maximizing my impact and really kind of living my purpose.” So one of the things I wanted to do today is put it out there for anyone listening who maybe uses collagen or MCT oil or whey protein. We really bend over backwards to source the best ingredients in the world, no additives, all that stuff. Everything is as clean as we can possibly make it. It takes a lot of work, working with manufacturers. Kind of like what you were saying, how patients have to know how to talk to their doctor. I don’t think people really realize, and I didn’t realize until I got on the inside, how much work it is for a brand to work with their manufacturers to convince them to get outside of the conventional mold. So it’s the kind of unconventional nutrition is really what we’re pushing here. So I set up a discount code for any Revolution Health listeners. Go to NaturalForce.com, use coupon code “unconventional” and get $10 off plus free shipping on your order. So I just want to put that out there as just a little extra bonus for anybody, and I would certainly love to help in that way and really get some good, high-quality nutrition into people’s hands. Chris:  Awesome. Yeah, and there’s so many ways people can help, and I ... at Paleo f(x) we’ve see the growth of companies that are serving this space, and it's amazing. Like the products that are available now. I had breakfast this morning, I had some eggs and kale and parsley and a little bit of bacon in a couple of cassava flour tortillas. Breakfast burritos. Whoever thought I’d be having a breakfast burrito again? Tortillas are made from completely cassava flour. They’re autoimmune friendly and they’re grain-free tortillas. It’s incredible. Tony:  I think I might have some of those in my fridge as well. Chris:  Yeah. I mean there’s so many things. And these people, they’re serving this movement with that kind of work. So it’s great to see. Tony:  It takes a village, man. Chris:  It does. Thanks again, Tony. I really appreciate it. Thank you, everybody. So again, Kresser.co/bonus to pick up your free audiobook and the other bonuses, and I hope you can all join me in this revolution to reinvent healthcare. We need you, whatever your background and goals. Take care, everybody.

Source: http://chriskresser.com November 08, 2017 at 04:12PM

[relatablyinsane-blog]

Quadpolar Part 2!

Just want to let you know that i had instant bloggers remorse after that last post. Welp, I've stepped in it now.

So i totally forgot to mention that I'm adopted (see: Symptoms of ADHD; rushing, inventiveness), pretty important stuff. That means my nice, old fashioned, very old, worked in the post office their whole life parents are not, in fact my real parents. What they did was reach into a barrel of discarded babies and pull out a meth head kid. (Sorry to my biological mom reading this, we have to go in context for a bit). For the sake of sanity my adoptive mom will be Mom and my biological mom will be Mama, although that didn't happen til MUCH later.

I was adopted at birth and told as soon as i was old enough to understand, something i appreciate my adoptive parents for. They never kept secrets from me, made sure i knew what sex was right off the bat, my super paranoid mom even gave me a book CALLED "Child lures" (I'm not kidding this was literally a pedophile's handbook for a seven year old to read, look it up. Fucked up.) But as far as how true it all was, maybe I'll never know.

What I was told by my adoptive mom was that my biological mother was a drug addict with two other kids already (my sister was 4 and my brother was 2). My father, who she was with at the time, was also a drug addict. As the story goes (i still haven't dared to ask), while high on meth one day he beat my baby brother so bad that his ribs and arm were broken and he now has permanent neurological damage. Last i knew my brother had just gotten out of jail and was homeless, so his life hasn't really improved. That was about the time the state of Arkansas decided that my mother, pregnant with me at the time, would no longer have custody of her children and we would all be placed for adoption immediately. My sister and brother, who shared a father that was different from mine, were placed in an orphanage and my Mama chose my adoptive parents to take me from birth. I had no correspondence with her for decades and didn't want to- to me she was a vile, despicable woman like all the drug addicts in the world- but i had mever even met someone on drugs so what did I know? So, born in Arkansas, raised in New Jersey and then....

Fast forward to the good part: the part that sticks my crazy ass in the awful state of Maine. I liked vacationing there, but did i want to move there? Hell no! My one best friend in the world, the boy next door who I'd grown up with and was the same age as, was not coming with us. It was in the middle of nowhere, on the eve of my Fifth grade year. Having skipped a grade, I was only 9 at the time. I distinctly recall my first car ride to the rural beach town, during which I had a small mental break down and screamed "THEY'RE DRIVING TRACTORS ON THE ROAD!!!" because that was just <i>unheard of.</i> The only kid on the street, eventual cheer captain, straight A student and model child was my age but wanted nothing to do with the hyperactive menace next door who came over uninvited and played with the dogs. Yep, that was me. Forcing myself into the company of people who didn't want me around.

And thus I started school at the local K through 8. Wait. K through 8? How many kids went to this school????? Must be like TEN THOUSAND!! Back in Jersey there were 2-3 grade levels to a school, 30 kids to a class and 11 of each grade.That's over 600 kids in just two grades! (And i still had no friends. Sob. Seriously i must have been an awful kid.) You never had the same classmates twice, classes switched every grade. I couldn't imagine how FRIGGEN HUGE a school with every grade in it would be!!

What? What's that. There are HOW MANY kids in my class?

16. And how many in the grade? 16.

....so there's one fifth grade? And how many kids in the school??? ......a little over a hundred.

WHAAAAAAAAAAAA.

At first i was pumped. I get to make friends and stay with them all the way till high school?! YES. Except this was when I remember my life becoming a living hell.

At this point i had been on at least three different medications for ADHD and none of them worked. Ritalin, Concerta, Stratera etc. Apparently i was still as annoying as ever because i remember being tormented relentlessly. Like, relentlessly. When there's only 16 kids in the class and you're the target, there's no escape. The teacher's let it happen. I was called hippopotamus. My lunch got spat in. I was mocked in front of the class. I was called stupid. Everyone would argue about having to sit next to me and i would just sit alone, or if someone did have to sit with me (usually the teacher assigned someone which made it worse) they would push my things off my desk or ask to copy my work once they realized i was almost as smart as the smartest girl in the class.

And i let them. I wanted SO fucking badly to be popular, to have a friend, fucking anything. It always blew up in my face. As soon as i was done being used for answers, a good place in line, a random good pick for a team or something, i was immediately shunned again. I buried myself in my extracurriculars (now it was swim team, violin and piano), joined band, chorus, jazz band, softball and soccer. I told my parents very little unless they were being dragged in for parent teacher conferences about how i was inattentive and always acting out. My grades began to slip because I was starting to learn about depression and constantly forgot to do my homework. My strict as hell parents were making me practice piano and violin for hours a day and my only solace was my meager 30 minutes of Nintendo 64 time per day. At one point my sixth grade teacher (stupid bitch, i hope you enjoy your cancer (sorry, y'all)) told my parents i wasn't as smart as everyone said and i should be held back because she thought i was autistic. I'm a lot of things, but not fucking autistic.

In the summer before seventh grade i finally got a reprieve in the form of my still longest best friend and the miracle drug Adderall. For those who don't know, Adderall is an amphetamine based ADHD medication and widely abused for it's stimulant properties. For anyone with ADHD however, it mellows the shit out of us and makes us super focused. Well, I'm a little allergic to it, so it actually makes me aggressive. On top of that, it makes your appetite nonexistent so, surprisingly, your favorite curvy girl Jay developed an eating disorder. Not on purpose at first. I just wasnt hungry so i didn't eat. I skipped breakfast, skipped lunch, ate the light dinner my parents prepared and went to bed. Hunger was nonexistent. Then one day i woke up and discovered myself at about 135 pounds, i tried on my first pair of short shorts out shopping with my mom. I'll never fucking forget looking in the mirror and saying out loud "Wow... I actually look great in these!" I didn't realize it was the Adderall at the time but I let it get worse. Whenever i did eat off my only light dinner schedule i would make myself throw up. I eventually got down to 117 pounds. My lowest weight. I stayed there for years. Once i had a state ID with me at that weight. Even at 12 i looked emaciated. It was revolting. I kept that ID for awhile to remind myself how awful i looked and to remind me that I look better curvy, but then i got fat and it made me sad. But i digress.

When i got back to school I suddenly gave not a single fuck about anyone picking on me. Adderall made my emotions <i>nonexistent</i>, but my temper started to boil. As a punching bag i was still pretty friendly and docile, like a big dumb dog that comes trotting back for another beating time and time again. Now i was silent and glowery. People took notice, and that's where my first real best friend came in. Let's call her Patti. I will always remember the day it really happened. I was the first person in line for recess, a great honor, but all my classmates were playing the "EW I DON'T WANT TO STAND NEXT TO HER" game. As per usual. I didn't really care. Thank god for drugs amirite? But then one voice rang out above the crowd of heckling...

I'm just kidding, it was more of a frustrated "seriously guys? Grow up." and then there was Patti. Someone who'd never joined in the terrorizing- i didn't and still don't blame anyone who didn't speak up. It would have made them a target too. But why? She was a cheerleader. I don't think anyone disliked her. She wasn't "popular" but she'd been going to this school since kindergarten and knew everyone. I guess I'll never really understand. But she was a lifesaver, even before the depression got really bad. She actually got to know me, the real me, she realized (and helped me realize too) that i was funny, and goofy and smart, and friendly. Eventually, because of her, some of the others started to come around too, but none of them were ever quite as close to me as she was. I thank god for this girl pretty regularly. Not as much as i should lately.

But there was still the matter of the bullies- and of my short fuse. I had my first kiss that year and a few short lived "boyfriends"- all from other schools of course, it would have been an unforgivable taboo to be interested in Jay. But that year was the year i put my foot down. As i mentioned earlier, Adderall had made me apathetic, but also very, very aggressive. The rage built slowly for several months until one fateful day in art class. I can't remember what i was doing to deserve this comment, i genuinely wish i could, but one of my usual enemies decided to say "No wonder your parents didn't want you!"

She was across the table from me and before i knew it i had launched myself across the table and had my hand up around her throat. No squeezing, just pressure. Her eyes nearly bugged out of her head and the entire room fucking froze. It was like something out of a movie. That was the first time i ever rage cried. If i ever get angry enough that my eyes start to water, someone's gonna get hurt. We both got sent to the principal, maybe because the sensible art teacher recognized a normally good natured kid snapping. I looked dead into that principal's eyes and told him that I'd had enough. I was tired of being picked on every single day and having nothing done. Teachers watched and let it happen. Some fucking joined in. HE let it happen after i told him time and time again what was going on. I didnt get in trouble. The bullying receded a good amount that day. It didn't stop completely until almost the end of the year.

Through my mother's networking at church i had become friends with one of the most popular girls at a neighboring school- a gorgeous russian adopted girl with a thick accent and a very early onset sex drive. Yikes. In turn, she introduced me to her brother, who i began "dating" for several months. By "dating" i mean we held hands and made out under the bleachers at YMCA dances and he tried to get me to give him a blowjob at my 12th birthday party. Jesus yikes. Needless to say that relationship didn't last long but I'd suddenly earned a reputation of someone who was- dare i say it- close to popular?

Then there was the summer of 2004. The best few months of my life. Patti and i were inseperable, we rode our bikes around the town every day, snuck into the state park, ate ice cream at the little trailer shop nearby, stayed up all night then nodded off through church the next day. And we dreamed. Oh sweet jesus did we dream about getting as far away from our shitty little town as possible and never coming back. I had honestly never been happier and for the first time in my life i had a best friend. I had a birthday party at the end of the school year and a bunch of people came- people from my school!- we genuinely had an amazing time. The girls all slept over and for once, finally, i felt like i belonged.

Eighth grade was a breeze, if you skim over Adderall making me almost punch my mom in the face. It was the first and last time i ever raised a fist to my parents. But it had done it's job. I wasn't getting picked on, i gained a little more weight and filled out nicely, I excelled at academics, won awards in jazz band, joined the bangor youth symphony orchestra, and actually made real friends (none in my school save for patti really.)

So.... That's my life up until high school. That's when i met depression. 😘

[jackednephi]

Hey asstit, I DID get the name right. Fuck your condescending ass post and your condescending ass tags. I know what I'm talking about and you should take every possible seat before you show your whole ass like this next time

I've been to therapy aka psychologists since I was 13. I've also seen psychiatrists since then as well. I turn 25 this year. I'm pretty sure I think I know what the fuck I'm talking about, my good bitch

There are no good psychiatrists. None. They're all bastards. They operate within a system that gives them nigh unlimited and unchecked authority over the mentally I'll. You piss off your psych and bye bye medications at BEST. They have the authority to have patients hospitalized nigh indefinitely and it will ALWAYS be their word of authority against yours. Good luck getting help if your psych decides you should be hospitalized. Trying to report any abuse no matter how minor is impossible and even then, 9/10 times, they won't get so much as a slap on the wrist. A good example was when my friend's doctor breached doctor patient confidentiality and got him not only expelled from his college but arrested for something he didn't even do because he was wrongfully deemed a threat. The doctor received no repercussions for the incident and is still happily practicing

Therapists do vital work and I have all the respect in the world for psychologists. Psychiatrists can suck a fart from the deepest recesses of my digestive tract. You can get good meds without one and I, my brothers, parents, husband, and other loved ones are testament. You just have to know what you're doing and, unfortunately, the mental health institution is built on people not knowing what they're doing

Seriously, try your shit the fuck again with someone else who doesn't know better. I've been wrongfully hospitalized and gotten the shaft time after time from psychiatrists. They are abusive and high off power the way cops are off theirs but a few steps in another direction. Instead of beating people of color and other minorities, they exercise unchecked control over patients

Thing is, asshat, I NEED medications not just to function but to not kill myself. I've been medicated since I was 17 and, had psychiatrists not been playing God with a vulnerable child's actual life, I would have been much earlier. I 100% should have been on medication and it took FOUR YEARS of self harm and suicide attempts before they would relent and prescribe what I needed. Doctors PLAYED WITH MY LIFE for FOUR WHOLE YEARS and were cool with me killing myself because oh noooo antidepressants could make it wooooorse. They SHOULD HAVE done their jobs and monitored me after prescribing medications but they didn't feel like it so my parents bore the heavy burden of an unmedicated, suicidal child knowing full well doctors could step in and help if they so chose but none were. We were also stuck on a military base with limited options

I'm not discouraging ANYBODY from medications. I myself see a psychiatrist. She prescribes me antidepressants and adderall. But I'm fully aware of the unchecked power she wields and that she can ruin my life if I don't toe the line. I have to adhere to a strict diet and exercise routine in order to stay within an acceptable weight or my meds go bye bye. My heart rate and blood pressure are the same so I CANNOT have had a bad day anywhere near my appointments. If I am late to more than three appointments with her or my therapist IN AN ENTIRE YEAR, she rescinds treatment and my meds go bye bye so I have to start the search all over again for someone new. All of this is seen as reasonable and par for the course making psychiatrists highly inaccessible for a vast majority of people for a wide variety of reasons

You weren't supposed to deep throat the boot but here the fuck we are. Go peddle your shit to somebody who doesn't know better

I want it known that if you are a psychiatrist or psychiatrist apologist, this blog is not for you

Same goes for cops and others in similar situations

Christ was deeply anti authority and we don't put up with that here

[shapesnnsizes]

RHR: A Three-Step Plan to Fix Conventional Healthcare

In this episode we discuss:

The patient case that inspired the book

Who is this book for?

The mismatch between our medical paradigm and chronic disease

Drug companies and conflicts of interest

How clinicians can help create a new paradigm

The three core problems and how to solve them

What this new paradigm looks like

How do we pay for this? Is it scalable?

How allied providers are the key

Show notes:

Unconventional Medicine by Chris Kresser

Special offer for RHR podcast listeners - get the audiobook free if you buy the book by November 12th.

NaturalForce.com - use coupon “unconventional” and get $10 plus free shipping

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Chris Kresser: Hey, everybody, Chris Kresser here. Welcome to another episode of Revolution Health Radio. Today we’re going to do something a little different. I am bringing on a guest host, Tony Federico, he’s the VP of marketing for Natural Force Nutrition, a physiology editor for the Journal of Evolution and Health, and a longtime contributor to Paleo Magazine, and also at Paleo f(x), which is where I met Tony, I think, originally, and I have interacted with him the most. And he’s moderated several panels that I’ve been on and I’ve always been impressed with the way he’s done that, the intelligent questions that he asks and just his balanced perspective on ancestral health and Functional Medicine, and this movement overall. Today is the day that my new book, Unconventional Medicine, comes out. It’s now available on Amazon, and I wanted to ask Tony to come take over the podcast and talk with me about the book because I know he’s really interested in all these topics and he’s read quite a bit of the book himself, and I thought it would be more interesting to have a conversation about it than for me to just sit here and do a monologue. So Tony welcome to the show and thanks for being here. Tony Federico:  Yeah, thanks for inviting me on, Chris. It’s always fun, when we’ve had the chance to chat, as you said. Whether in person or on podcast, I’m always happy to jump in and dish on health with you. Chris:  Fantastic. So, you have read a little bit of the book and we chatted a little bit about it via email, so let’s dive in. Let’s talk a little bit about this book. And for me it was really, it felt like the most important next step that I could take in order to get this message out about ending chronic disease. Tony:  Yeah, I got my copy of Unconventional Medicine a couple days ago. I just so happened to have some time off yesterday, and the next thing I knew I was 80 pages in. Chris:  Nice. Tony:  So, I have to say that, as somebody who’s been in the trenches, I worked as a personal trainer for 10 years, I could really relate to a lot of the things that you were saying in the book, and we’ll get into why a little bit later on in the interview. But you know I just am really impressed with what you put together here, Chris. So let's just, let's get into it, and the first thing that I actually wanted you to maybe tell me a little bit about was how you open the book, which I think is a really great story about a patient named Leo. So I wanted to talk a little bit about Leo and his story and kind of how that inspired you to go down this particular path of unconventional medicine.

The patient case that inspired the book

Chris:  Sure, yeah. So, Leo was an eight-year-old boy that I treated in my clinic a few years back, and I wanted to start with his story because it's, unfortunately, a typical story, much more common than, of course, we would like. And it was powerful for me, it was a powerful experience. It's what actually led to me writing this book. So, like way too many other kids of his age, he was suffering from a number of behavioral issues. He was initially diagnosed on the autism spectrum. Eventually they settled on OCD and sensory processing disorder. He would throw these just crazy tantrums where he'd end up crying or screaming inconsolably, writhing on the floor, and this would happen for seemingly the simplest of reasons. Like trying to get his shoes tied as they were going out the door, not cutting the crust off his sandwich in just the right way or getting a stain on his favorite T-shirt. And he was really rigid around his behavior and its environment, everything had to be just right, just the way he wanted it to be, or else he would fly off the handle.

Is a new healthcare paradigm affordable? Scalable? You bet.

His diet was extremely limited, he only ate a handful of foods, pretty much all of which were processed and refined. So crackers, bread, toaster waffles, that sort of thing, and this is part of the kind of OCD-like tendencies. And any time his parents would try to introduce new food, he would go totally ballistic. And they were worried about nutrient deficiency, but they didn't feel like they ... they were just worn down. Any parent who has a kid like this will understand that. It's just they didn’t feel like they had the resources to battle him at every meal. And they took him to a bunch of doctors locally, and that’s where they got those diagnoses. Initially they were kind of relieved to have those, but then after a while they realized that they were just simply labels for symptoms. And when they asked what the treatment was, you can probably guess the answer: medication. Tony:  Something to do with drugs. Chris:  Something to do with drugs. Yeah. And when they asked how long he would be on that treatment, you can probably also guess the answer. Tony:  The rest of your life. Chris:  Yeah. Shrug of the shoulders, indefinitely, maybe he'll grow out of it, that sort of thing. And they weren't excited about the idea of of medicating their son, but they were also aware of how much he was suffering, and they were suffering, frankly, too. They decided to give them a try, starting with Adderall, and then they progressed to Ritalin and then antidepressants. And certainly the drugs did seem to help with at least some of the symptoms, but there were a couple issues. Number one, they also caused some very intractable side effects like headache, abdominal pain, irritability, and most significantly, severe sleep disruption. And they had a couple of other kids that were younger than Leo. So they were not happy about the sleep disruption. Nobody was because it was brutal for them and also brutal for Leo. Kids need a lot of sleep, and if they’re waking up throughout the night, that’s going to make ... So that was in some ways worse than the original symptoms they were trying to treat. And then Leo's mom had done quite a bit of research on the effects of these medications and she was scared. Particularly for children and adolescents, some of these drugs have some pretty scary side effects and long-term risks. So what really stood out to me, and I mentioned this in the book, is that not once during this entire process of seeing all these different doctors, primary care provider, psychiatrist, eventually behavioral disorder specialists, did anybody even hint at the possibility that something in Leo's diet or some other underlying issue like a gut problem or nutrient deficiency or heavy metal toxicity or something like that could be contributing to his symptoms. It wasn't even broached as a possibility at any time. Fortunately, Leo's mom, one of her friends followed my work and sent her a couple of articles from my blog. One was on the gut–brain–axis, and I think the other one was on the underlying root causes of behavioral disorders. And so that's what led them to bring Leo to see me, and long story short, we were able to ... we did a bunch of testing, found issues that you might guess at. So, disrupted gut microbiome, SIBO, fungal overgrowth, gluten intolerance, but also intolerance of soy and corn and rice and buckwheat, which were major ingredients in a lot of the processed and refined food products that he ate, and arsenic toxicity because rice milk was the only other beverage he would drink aside from water. And we know that rice products can be high in arsenic. So, we, over several months, it definitely wasn't easy to address these problems because of his OCD-like tendencies and his picky eating habits. But after several months he was like a different kid. His teacher even called home and was like, “What have you done with Leo and who’s this kid that you’re sending in?” Because it was a big issue for her. They often had to come to school and pick him up early because of the behavioral problems. And his diet expanded; he was eating foods he would've thrown against the wall just months before, he was more tolerant of disorder, more relaxed in his environment. They were able to travel for the first time in a long time because he wasn't so anxious in unfamiliar environments. His physical symptoms had improved significantly. So they were just over the moon. They couldn't believe it, and toward the end of our treatment together, she said something that really struck me, which was there’s so many kids out there that are like Leo and they’re suffering, they’re not finding help in the conventional system. Tony:  Sure. Chris:  And their doctors and parents are not even thinking about this stuff. Like it’s not even in most people’s consciousness that if a kid has a behavioral disorder that you should look at these physiological issues. It’s not, for 99 percent of people they don't even go there because they don't know. Tony:  Yeah, I mean I think that that was—reading about Leo and reading about a story and certainly there's people that I've known, myself included, who have had very similar experiences—I think it's great to have a narrative like this that you can really connect to because then when you tease it apart, all the pieces really make sense. It makes sense why having doctors treat symptoms has failed, it makes sense why a lack of communication between the health provider network that was supposed to be serving Leo failed. It makes sense why it didn't work when you actually start to tease it out. But then we’re still all, well not all, but most of us are still going down this path and it's an exercise in futility, really. You have an eight-year-old kid who's on powerful stimulant medications, he’s on antidepressants, and it was bad enough for his parents to reach out and to seek those interventions as solutions, and then the side effects are even worse. And that’s just something that just gets you right in the heart. And like you said, he’s not the only one, he’s not the only kid. His parents are not the only parents. And frankly, his doctors are not the only doctors because I can guarantee you that that probably doesn’t really feel good for the practitioner, for the healthcare provider to not get results as well. And they’re working with what they’ve got. Chris:  Absolutely. Tony:  And trying to use the tools they have. Chris:  Yeah, I mean, let’s be clear about this. Everybody is doing the best they can in this situation. The parents are doing the best they can, in the vast majority of situations, parents just love their kids and do everything possible that they can to help their kids thrive. I’m a parent, I know that that’s how I relate to my kid. I know that every parent I know, that’s how they relate to their kids. And I would even, I would say that’s true for doctors too. The vast majority of them are trying to do the best they can with the tools that they have and in the system that they’re working within. And that’s the rub. Tony:  Right. Chris:   It’s like most doctors I’ve seen have been caring and they’ve wanted to do the right thing, but the question is, can they do the right thing in the conventional medical system as it exists today? And, of course, that’s largely what the book is about.

Who is this book for?

Tony:  Yeah, so let’s kind of speak to that specifically. And we’re talking about doctors, we’re talking about medical professionals, we’re talking about patients, and then we didn’t mention it, but where I fit into this formula or potential formula as an allied healthcare provider, as a personal trainer/health coach, is that your audience for this book, do you really see that kind of triad is who you're speaking to here? Chris:  Yeah, definitely. I think if you look at the cover of the book, the subtitle is “join the revolution to reverse chronic disease, reinvent healthcare, and create a practice you love.” So that last bit would suggest that it's mostly for practitioners, but that's not true. It is really for anybody that is interested in the ideas of reinventing healthcare and reversing chronic disease. And, in fact, I would argue that that change is going to be initiated by people, primarily by people that are not practitioners. So it's like a grassroots, bottom-up approach, where a good example is with my training program, my ADAPT training program, now that we've been training practitioners in this approach for the last couple years, we always ask people how they learned about my work or how they learned about the training program. And in a surprising number of cases, the answer is from their patients. So these doctors or other practitioners, their patient brings an article in that I wrote or brings something in, tells them about me, and to their credit they’re open-minded enough to go and check it out. And then they like what they see and they end up taking the next step. So people even who have no intention of ever becoming a healthcare practitioner, I think would really benefit from this book if they're interested in these ideas. And then certainly, as you mentioned, licensed healthcare providers like medical doctors or nurse practitioners or physician assistants that are currently working within the conventional paradigm but have already seen its limitations and want to do something different but don't yet know what that might look like. And then people who are outside of the conventional paradigm but are already practitioners, so acupuncturists, chiropractors, naturopathic physicians, etc., in many cases they’re already well aware of the limitations of conventional medicine, which is why they chose to go down a different path. But speaking personally as an acupuncturist myself, I also saw some limitations in the traditional Chinese medicine approach, or at least some differences in the way that I wanted to practice it. I was looking for something that could incorporate modern diagnostic testing and create a more systematic approach that included ancestral diet and lifestyle and some of the other things we talk about in the book. So, I think many of those practitioners can benefit from the book from that perspective. And then you have the growing and already large number of people like yourself who are personal trainers, health coaches, nutritionists, etc., who I really think are going to play an increasingly important role in this revolution to reinvent healthcare. Tony:  Yeah, it so important now for people to really, for patients to be their own advocate, and I don't think we’re living in a time where I remember with my grandparents—if your doctor said something, it was basically gospel and you didn’t question it and you didn't think about it. Now, the first thing people do when they experience a symptom, it's Dr. Google first. So it's super important to equip and arm patients with good information, which I think this book does. Here's a path, here's a path forward for you as a patient. But then it's respectful of the role of doctors, and you highlight many situations where conventional medicine is great. If you break your arm or get in a car accident or have a heart attack or whatever the case may be, yeah, you need a doctor, and you need to go to an emergency room and you need those types of interventions. But it's really in this kind of gray area, it’s really not gray, it’s actually quite clear. And we could probably specify a little bit more, but there’s this middle zone where somebody’s not acutely injured, they’re not acutely in a disease state. They’re in a chronic disease state, or they’re just unwell. And it’s hard for a system that is all about pharmacological interventions, surgical interventions, to deal with a more subtle approach. And that’s where that whole middle ground and acupuncturists and massage therapists and everybody who's in that middle zone. I had clients constantly when I was actively training, constantly asking me questions where I was like, you know what? This is really something they maybe should be taking to their doctor. But guess what? The doctor only has 15 minutes under pressure to see as many patients as they can. I had a friend who was a physician in France. And he was telling me about their medical model, and he would spend tons of time with his patients. And it was actually incentivized for prevention. And here we see some maybe misplaced incentives, and perhaps you can speak a little bit more about that.

The mismatch between our medical paradigm and chronic disease

Chris:  Yeah, so, going back to your original comments, I think that the most important thing for people to understand is that our medical model, when it comes to our medical paradigm, is that it evolved during a time when acute problems were the biggest issues. So in 1900, the top three causes of death were all infectious diseases, tuberculosis, typhoid, and pneumonia. And the other reasons people would see the doctor were among those you mentioned, like a broken bone or a gallbladder attack or appendicitis. Tony:  War. Chris:  Right, injuries, trauma, etc. And so the treatment for that's pretty straightforward. It wasn't always successful, of course, but it was straightforward. You know, if the bone was broken, you set it in a cast. If the gallbladder was swelling, you would take it out. If someone was having appendicitis, you’d remove the appendix. So that's pretty ... it's one problem, one doctor, one treatment. Pretty straightforward. But you fast-forward to today, it's a totally different healthcare landscape. Seven of the top 10 causes of death are chronic disease rather than acute problems now, and 86 percent of the healthcare dollars we spend go toward treating chronic disease. And unlike acute problems, chronic diseases are expensive, difficult to manage and usually last for a lifetime. They don't lend themselves to that one doctor, one problem, one treatment kind of approach. The average chronic disease patient requires multiple doctors, usually one for every different part of the body in our system, and is taking ... Tony:  Specialists. Chris:  Right, specialists, they’re taking multiple medications in many cases, and they're going to be taking those medications for the rest of their life. So far, it's really, our conventional medical system is amazing for these acute problems. But it's the wrong tool for the job for chronic problems. So that's one issue, and it’s really important to point that out, because we just went through the whole healthcare debate again with the Affordable Care Act and the current administration’s proposal for a replacement, which has not come to fruition. But throughout that entire discussion, it really bothered me that there was an elephant in the room. All the discussion was around insurance. Like, who gets insurance and who doesn’t. And that’s important, it’s important to talk about that. But we have to recognize that health insurance is not the same thing as healthcare. Tony:  Yeah. Chris:  Health insurance is a method of paying for healthcare. And that’s really crucial to get that difference. Because my argument in the book is that there is no method of paying for healthcare, whether it’s the government, corporations, or individuals, that will be adequate and will be sustainable under the pressure of growing prevalence of chronic disease. It will bankrupt all of us. Government, the corporations, individuals, whoever is responsible for paying for the care will not be able to do it unless we can actually prevent and reverse chronic disease instead of just slapping Band-Aids on it. Tony:  I think the analogy you gave in the book was rearranging the deck chairs on the Titanic. “Making a few small tweaks to our current system and expecting that to work is like rearranging the deck furniture on the Titanic as it inexorably sinks into the ocean. Too little, too late.”  Chris:  Yeah, exactly. That’s the argument about insurance. As the whole ship goes under, sinks under. The other problems you mentioned are very real also. So we have a misalignment of incentives, like the insurance industry, for example, doesn't benefit when the cost of care shrinks because they only make more money when the overall expenditures rise. So it's actually not in their best interest necessarily to seek out the most cost-effective solutions.

Drug companies and conflicts of interest

Chris: And then of course, we have drug companies. People are pretty well aware of the conflicts of interest there. It’s in their interest to sell drugs, and even when that’s not in the interests of the general public or the patients or the doctors. In many cases, it’s not in their interest either. So the best example of this is a recent one. We’re in the midst of an opioid crisis, the worst we’ve ever seen by far, and the DEA has been wanting to create new regulations that restrict a pharmacy’s ability to sell opioids in ways that will protect people. So, for example, there was a pharmacy in West Virginia in a town that was tiny. It had like 30,000 people in this town, and they had ordered something like nine million opioid pills in the last year. It was clearly a front, like there’s clearly something shady going on there. There's no way that 30,000 people in that town needed nine million opioid pills, and yet there are no regulations to actually prevent that from happening. And so, the DEA had proposed some regulations to just safely protect people from that kind of thing. And the Big Pharma lobby basically shut that down and they played a big role in writing a law that limits the DEA's ability to do that kind of regulation in the midst of the worse opioid crisis ever. And to put this in perspective, we hear a lot about the gun lobbies and their control. They spend about $10.5 million lobbying Congress, I think, per year. And Big Pharma, they spent $250 million. Tony:  Wow. Chris:  Twenty-five-fold higher. Tony:  It's really tragic. I actually, I don’t think we’ve ever talked about this, but I grew up in South Florida, which was kind of ground zero for the opioid epidemic. And I remember in high school down in Miami and West Palm Beach, and kids would get a hold of a contact or whatever, somebody that had a prescription and basically would end up being a de facto drug dealer vis-à-vis a pill mill, etc. The kid across the street from me died, multiple kids in my high school died, multiple kids went into in-treatment programs, some of them battled addictions for decades. Some of them got out of it. Very few got out of it. Some of them didn't and have continued to be plagued with either switching from pharmaceuticals to street drugs like heroin, etc., and then we can see what's happening there. And that's just one example. If we look at drug consumption in the United States, is it that Americans are just that much sicker and we’re in that much more pain than people in other countries? Because we’re consuming far and away more painkillers than any other country on the planet. And I would venture to guess that you could say the same about antidepressants or ADD medication. It's very much a case of misaligned incentives. And incentives are working in the sense of the pharmaceutical companies are doing very well. Chris:  Yeah. Who are they working for is the question. Tony:  Exactly. Chris:  We’re the only country aside from New Zealand that allows direct-to-consumer drug advertising, and I think that's a big part of the problem. But it's not just Big Pharma. We also have conflicts in medical research that, of course, are related to Big Pharma because they pay for two-thirds of all medical research. We have broken payment models, where there's no real incentive or reward for good performance, and in fact, you could argue it's the other way around because doctors are compensated for, usually based on the number of procedures they order and the number of patients they see. So to your point about the doctor in France who is actually incentivized to prevent, rather than just treat disease, we don't have that at all, it's the opposite. And so there are a lot of deeply entrenched issues that we certainly need to address, and that's not essentially what this book is about. There are other books that cover that material really well, and frankly many of those issues are outside of our individual control as clinicians or practitioners.

How clinicians can help create a new paradigm

Chris: We can work toward addressing them, and I think we should, but the good news is that I think that the bigger changes that we need to focus on individually and collectively are addressing the medical paradigm which we’ve talked about, creating a medical paradigm that’s better suited to tackle chronic disease. Addressing the mismatch between our modern diet and lifestyle, and our genes and our biology, which we've, of course, talked a lot about on the show before. And then creating a new way of delivering healthcare that actually supports this new medical paradigm and this more preventative approach. Because those things are all within our control as clinicians. Tony:  Yeah. I like how you posed the question, and it was kind of a cool little, I think it was, not Hiroshi, but the person who is in charge of cooking at a Buddhist monastery. And basically a young monk comes up to this older man. He’s like, why are you doing the grunt work, basically washing rice out in the courtyard? And he says, it was like, what was it? “If not me, who? And if not now, when?” And I think that that’s really kind of the core of setting all this stuff up. Talking about the problem is really in the service of pivoting to the solution, and I’m a big believer in thinking globally, thinking big, but acting locally, hyper-locally, like yourself. Chris:  Yeah. Tony:  And then the people around you and who you can touch and impact. That’s ultimately where the power comes from. So let’s talk about that. What is in people’s power. And you started to describe some of those pillars of a new model. And you describe it as the ADAPT framework. And I don’t know how much you get into this on your regular podcast episodes, but to just kind of lay it out, ADAPT from a big-picture perspective. How does that actually address some of these systemic issues from an individually empowered stance? Chris:  Yeah, great question, and before I even go into that, I just want to say I agree that I think the change is going to happen on different levels. So, because a lot ... we’ve talked about this stuff at conferences or even some people who’ve already read the book. They say, oh, this is fantastic. I’m so excited. But how are we going to deal with Big Pharma and the insurance industry and these misaligned incentives and all of that? And can we ever deal with that? The answer is we’re not going to deal with that overnight and it’s going to take a while to unwind those things. Tony:  It’s the chronic disease, is what you call... Chris:  Exactly, exactly. And I use that analogy in the book. But the good news is that changes can happen very quickly on an individual and local level. And there’s already a lot of evidence of that happening. So my own clinic, CCFM, tripled in size in the last three years alone. We have Cleveland Clinic Center for Functional Medicine, launched by Dr. Mark Hyman, has just blown up like crazy. I mean they started in this tiny space. Now their 17,000-square-foot space, it takes up the whole second floor of the Glickman Tower at Cleveland Clinic. They've got a waitlist of 2,500 patients from nine countries around the world. This is really exciting! The Cleveland Clinic is always on the forefront of the newest trends in medicine, and the fact that they've invested that much money in this speaks volumes. Then we have groups like Iora Health, an organization based in the Rocky Mountain area that’s reversing diabetes using health coaches. So there are lots of really interesting produced concepts, and there's going to be more and more of these. Like we’re doing a pilot program with the Berkeley Fire Department where we’re working with their new recruits to help, we’re implementing a wellness program. Tony:  That’s awesome. Chris:  To reduce injuries and help with recovery and optimize their performance. And if that goes well, there’s been interest from the wider fire department and in the city of Berkeley as a whole. Robb Wolf’s done some incredible work with Reno that we’ve talked about before. So I think the change is going to happen more quickly on this local grassroots level, and then that's going to start to get the attention of people on a state and federal level. And then it will start to get really interesting.

The three core problems and how to solve them

To answer your question, in my book I basically lay out three core fundamental problems with the healthcare system in the US. And these, I argue, go even deeper than the misaligned incentives and Big Pharma and all of that stuff, although they’re, of course, connected. The first is that there is a profound mismatch between our genes and our biology and our modern diet and lifestyle. And I'm not going to say more about that now because almost everyone listening to this podcast knows exactly what I mean. The second problem is the mismatch between our medical paradigm and chronic disease, which we just talked about. We need a new medical paradigm that is better suited for chronic disease. And then the third is that the way we deliver care in this country is also, it's not set up to support the most important interventions. And we’ve touched on that too, where the average visit with the primary care provider is just actually eight to 12 minutes. Tony, you were talking about 15 minutes. That’s luxurious in our current model. The average amount of time a patient gets to speak before they’re interrupted by the doctor is 12 seconds. Tony:  Wow. Chris:  So I think it’s pretty clear that if a patient has multiple chronic diseases, which one in four Americans now do, one in two has one chronic disease, and they show up to the doctor’s office and they're on multiple medications, and they had been presenting with a whole set of new symptoms, there’s absolutely no way to provide high-quality care in a 10-minute visit. So we have to change our, not only the paradigm, but also the way that care is delivered. So that was my premise. So it follows then that my solution would address, I would hope at least those three points, right? Each of those three deficiencies. So the ADAPT framework combines an ancestral diet and lifestyle, which addresses that mismatch between our genes and biology in our modern diet and lifestyle. And then Functional Medicine is the new paradigm of medicine that is based on addressing the root cause of health problems, so we can prevent and reverse them instead of just suppressing symptoms. And then the third component is what I call a collaborative practice model, which links licensed providers like medical doctors, nurse practitioners, with what I call allied providers, which include folks like yourself, Tony, health coaches, nutritionists, personal trainers, etc., to provide a much, much higher level of care than what doctors are able to provide on their own. So, again, we're not trying to replace doctors in any, or even conventional medicine. We need people to do colonoscopies and remove cancerous tumors and use all of the incredible amount of training and expertise and skill that they’ve acquired over a lifetime of practice and study. We absolutely want that, but we need to add stuff to that that's not available now. Tony:  What that really says to me is, emphasize the importance of community, of connection, of collaboration. We’re social creatures, we’re tribal by nature. That’s another kind of Paleo/ancestral health part of the puzzle. And it would be foolish to think that we can dissect out and silo out all these different aspects of our lives without consequence. I really like this idea of bringing everybody into the fold, and it’s not saying that you can go to just the naturopath, or you can go to just the health coach. Because like I mentioned already, I certainly would’ve been ill-equipped to handle plenty of issues that a client would’ve brought to mind or brought up in conversation during a training session. But it would’ve been really great to say, ah, here's the Functional Medicine practitioner that I recommend you speak with, and to have a good relationship with that person and to be able to, as a health coach, help my clients better by getting them in touch with the right person. And that’s having this network that can really support people throughout their health journey whether it’s just feeling better and more energy, or addressing something like diabetes or hypertension. Which certainly there’s a place for all the players in that kind of scenario.

What this new paradigm looks like

Chris:  Absolutely. And let’s use an example just to bring this to life for people. So, imagine you go to the doctor and they do some blood testing for your annual physical. And they find that your fasting blood sugar is 96 or 97. Your hemoglobin A1c is 5.5, and you’ve got triglycerides that are 110, 120, maybe 130. Currently, what would happen is nothing, usually. Tony:  You’re not sick enough yet. Chris:  Yeah, all of your markers are within the lab range, they say, and that means you’re normal, and so you might get some vague advice about make sure to exercise and follow a good diet. And thank you very much, that’s it. Certainly there are exceptions to the rule, of course. There’s some practitioners who can get a lot more proactive about that. But I can’t tell you how many people, patients I’ve had that have been given that basic line with those kinds of lab results. What could happen is this. The doctor says, “Well, you know, if we think of blood sugar disorders on a spectrum, on the left you’ve got perfect blood sugar. On the right you’ve got full-fledged type 2 diabetes. You’re not on the right yet, you don’t have type 2 diabetes or even technically prediabetes, but you’re progressing along that spectrum. And what we know from a lot of research is that if we don’t intervene now, that you’re going to continue progressing. And in fact, we have studies that show that the average patient who has prediabetes, will progress to full-fledged type 2 diabetes in just five years if it’s not addressed.” So what we want to do is be proactive here. We want to intervene now because it’s much easier to prevent a disease before it occurs than it is to treat it after it’s already occurred. So here’s what we’re going to do. We’re going to set you up with our staff health coach, and they’re going to give you all the support you need to adopt a better diet. They’re actually even going to take you shopping, they’re going to come to your house and clean out your pantry with you, and they're going to give you recipes and meal plans and give you ... totally hold your hand and do everything that they need to to get you on this diet. Because we know that information is not enough. We’ve got lots of studies. I can tell you as a doctor, go eat a healthy diet, and hey, we know that that’s probably not going to happen. Most people know what they should be doing, but they’re not doing it, and it’s not because of lack of information. It’s because they need support, and we’re here to support you. We’ve got this health coach. Furthermore, we've got this great personal trainer named Tony. We’re going to set you up with him and we’re also going to set you up with a gym membership. And the good news is, your insurance is going to pay for all this. They’re going to pay for the health coach, they’re going to pay for the gym membership, they’re going to pay for your sessions with Tony. And in six months’ time, you’re going to come back here and we’re going to retest your blood markers and I can almost guarantee that if you stick with the program, you’re going to have normal blood sugar by that time. And throughout that period you’re going to have weekly check-ins with a health coach, you’re going to have training sessions. And not only will your blood sugar be normal, you’re going to lose weight, your energy levels are going to go up, your sleep’s going to get better, you’re going to feel more confident and empowered because you’re making these changes, and you’re going to feel like a different person. Now that’s totally possible.

How do we pay for this? Is it scalable?

Chris: I can hear some people saying, “Oh, how are we going to pay for that? That’s ridiculous.” Tony:  Is it scalable? Chris:  The question we should be asking is, is treating type 2 diabetes scalable? Because I mentioned this in the book, it costs $14,000 a year to treat a single patient with type 2 diabetes. So let’s imagine that this patient progresses. We don’t intervene, five years later they have type 2 diabetes. All of a sudden the healthcare system is spending $14,000 a year paying for that person’s care. And let’s say that that person gets diagnosed at age 40, which is still reasonable these days. The age of diagnosis is dropping more and more, and then let’s say that they live until they’re 85 years old, which is also possible because of our heroic medical interventions that keep people alive a lot longer than they might have been otherwise. So 45 years living with type 2 diabetes, that’s a cost of almost $650,000 for one patient to the healthcare system. Tony:  And that doesn’t even touch on the lost wages, cost to employers, when someone’s on leave, loss of productivity. And then the cost to the family members. Chris:  Absolutely. Tony:  People that are actually, are helping the patient, their health is going to be going down too. Chris:  Yeah. Nor does it touch on the qualitative aspects. Being immobilized, not being able to play with your grandkids, all of that stuff. But let’s just even forget about that for a second—$650,000, okay? And then the CDC recently came out with statistics saying that 100 million Americans have either prediabetes or diabetes, and 88 percent of people with prediabetes don’t even know that they have it. Which means they're almost certainly going to progress, right? If you do the math and you multiply 100 million people times even $14,000 for one year, you get a number that’s so large, I don’t even know what it is. It’s like a google something. It’s like, it has so many zeros after it, I don’t even know how to characterize it. But then if you multiply 100 million times like 20 or 30 years, it’s more money than there is in the world. It's like it's not going to happen. Tony:  Not sustainable, not scalable. Chris:  Not sustainable, not scalable. So let’s say in our example that we ... the healthcare system spends $10,000, which is way more than would be necessary, but let’s even say we buy the person’s groceries for three months. And their gym membership and their trainer, and their health coach, and those weekly, let’s say we spend $10,000. We’re just super generous and we spend $10,000 for that six-month period. Again, the research and my clinical experience indicates with near certainty that if the person is at that stage of not even prediabetic and we intervene, there’s like almost no chance that it’s not going to, we’re not going to be able to normalize that person’s blood sugar. And if they do that and they stick with it and they are able to do that because they now have support rather than just information, we’ve just saved the healthcare system $640,000 over the course of that patient’s lifetime. And that’s a conservative estimate, as you say. We're not including even the indirect costs. Tony:  Right, right. Chris:  I think that this is not only possible, it's going to become necessary. And whether we get there with a proactive approach where we decide to move in this direction and we make these changes or whether we get there because we absolutely have no choice, we’re going to get there. Tony:  Yeah. I mean it really sounds like we can’t afford to not do this. Chris:  Exactly. Tony:  And if we get to that point where we continue down the reactive path and we wait until there’s a total collapse, it might be too late, just to put it frankly. And it’s going to come out at a huge, not just financial cost, a huge human cost. Chris:  Yeah, it’s going to be, we can use the chronic disease metaphor again, it’s a lot easier to prevent a problem or reverse it at an earlier stage than it is to wait until the patient is essentially on life support or the healthcare system is on life support. It’s harder to reverse it at that time. And that’s of course why I’m writing the book now because I want to get this message out as far and wide as I can. Tony:  Yeah. If not now, when? If not you, who? Go right back to there.

How allied providers are the key

Chris:  Exactly. And one more thing about that is the amazing thing, the beauty of this is that it takes about eight years and hundreds of thousands of dollars to train a doctor. And it takes a certain kind of personality and a certain kind of comfort level with science, and a lot of prerequisites. It’s not for everybody. And there’s a ... already we have a shortage of doctors, and that’s predicted to get worse. I’ve seen estimates that suggest by 2025 we’ll have a shortage of 52,000 primary care physicians. So that’s a big deal. [insert image] So we already don’t have enough doctors, it’s already going to get worse, but if you think of healthcare as like a ... I have something in the book called the healthcare population pyramid. And you were referring to it earlier, Tony, where at the very top of that pyramid you’ve got 5 percent of people who are in really acute situations. So they’re in the hospital or they’re in an intensive outpatient care setting. They need the conventional medicine paradigm as it exists, and it’s fantastic for those situations. Then you’ve got another 25 percent of people in that kind of high middle of the pyramid who are dealing with some pretty serious chronic health challenges. So they require more regular care, but they’re not sick enough to be in the hospital or in any kind of ... they’re living their lives, but they’re struggling a lot. A Functional Medicine practitioner/clinician usually working in concert possibly with the conventional specialist of some kind is a really great option for that 25 percent of the pyramid. But then you’ve got the 70 percent at the bottom. So these are people who do, may have health issues, but they’re more minor, so they might have skin problems, or a little bit of brain fog, some difficulties sleeping, some GI issues. And these can be definitely debilitating and total pain, but they’re not at the level of that 25 percent. My argument is that in many cases these people could be very well served by a health coach or nutritionist with good training. And possibly seeing a Functional Medicine provider once or twice a year, or something like that. And the thing is, we can train people in a year or two without an extensive science background to be very, very objective in this role. Because they’re mostly working with patients on changing their behavior. If you think about it, most of the risk factors for chronic disease come down to the wrong behaviors. Eating the wrong diet, not getting enough sleep, not exercising, or exercising too much, or any number of things that come down to choices that we’re making. And so if a skilled health coach who’s trained in things like motivational interviewing and coaching to strengths and other evidence-based principles of facilitating behavior change which we have a ton of research on, they can be incredibly effective for that 70 percent of the population. That's the majority of the population. So we’re totally underutilizing these practitioners, and my argument is that they’re going to play a huge role in this future of medicine. And that's of course one reason why we're launching an ADAPT Health Coach Training Program next year to complement the practitioner training program that we've been doing. Because I want to create this ecosystem we've been talking about where you have all of these different types of practitioners working to the maximum of their training and ability and scope of practice and supporting each other and therefore providing the highest level of care to patients. Tony:  That certainly kind of perks my ears up hearing about the ADAPT health coach option and something that I’m personally interested in. So who knows? Maybe I can get in on that. We can talk about it again in the future. Chris:  Yeah, for sure. For sure. Tony:  So, for this particular book, for Unconventional Medicine, people are fired up, they’re hearing about it, they’re like, “Okay, this resonates with me. I’m a practitioner, I’m an allied health provider, I’m a patient, I’m ready. Now’s the time. This is it. We’re going to do this.” What’s the best way for people to get their hands on this thing? Chris:  Well not surprisingly, Amazon. They have the best way to get your hands on anything. So it’s available in paperback, Kindle, and audiobook. We’re hoping [the audiobook] is going to be out today, the day this podcast is released. But it might be another two or three days. They’re just taking their sweet time to approve it. I narrated the audiobook myself. So you podcast listeners, I figured you might be into that, since you like to listen. Tony:  They know your voice. Chris:  Yeah, and just listening to something instead of reading it perhaps. So to that end, we have a special offer for podcast listeners, because I appreciate your support and I know many of you are already part of this movement, and some are wanting to get involved. So if you buy that paperback or Kindle version between now and Sunday night, you’ll get some really cool bonuses. The first is a free copy of the audiobook. So again, we wanted to include that for podcast listeners, since we figured you guys and gals are probably interested in audio. But there are two other things that are really, I think, fantastic. And one, they’re both tools to help you be more confident and persuasive and factual when you share your passion for Functional Medicine and an ancestral diet and lifestyle. Because we’ve had a lot of questions from people, both practitioners and non-practitioners alike. They say, “Oh, how do I talk about this stuff to my sister at Thanksgiving?” Tony:  “Isn’t that that caveman diet?” Chris:  Yeah, exactly. All of our ancestors died when they were 30, so why should we even care? How do you respond to those arguments? Or if you start talking about Functional Medicine and maybe one of your conventional medicine colleagues says, “Oh, that’s just, I saw something on Science-based Medicine that said that was all just hooey. There’s nothing to it. How do you respond to that?” So what we wanted to do is give people the ammunition they needed in a respectful way. You know, this isn’t about getting the better of somebody. It’s about responding in a factual and convincing but respectful way. So we’ve got two different, we’re calling these the Power Packs. And one is for practitioners, so clinicians, health coaches, nutritionists, trainers, etc., and these are facts, research that you can reference and persuasive reasons for your clients or patients or colleagues to consider this Functional Medicine and ancestral diet and lifestyle approach. And then we have one for non-practitioners called the Supporter Power Pack. And these are smart answers and compelling comebacks, again respectful, for those common objections that you hear when you start talking about this stuff with your friends and family. So these bonuses are available until Sunday night [November 12, 2017] at 11:59 p.m. Pacific Time. So you’ve got a few days to act on that, and you can go to ... we set up a special link for you to get these and that’s Kresser.co/bonus. That’s Kresser.co/bonus. So head over there to get your Power Packs and your free audiobook, and that’s after you purchase either the paperback or Kindle. There’ll be a place where you enter your order number and we ask for some information just to verify, and I hope you enjoy those and get a lot out of them. Because they were actually really fun to put together. Tony:  Yeah, I think the audiobook is huge. I like to listen to audiobooks when I’m driving around town or outside getting some exercise. Chris:  Yeah. Tony:  So, no excuses when you make it that easy. Chris:  Yeah, yeah. So, Tony, thanks so much for doing this. This has been really fun to talk to you, as it always is. And I appreciate it. Tony:  Actually, I wanted to throw in one extra little special thing, as we mentioned, at the top of the show. I spent 10 years as a personal trainer in the trenches, I was involved with Paleo Magazine for many, many years, going to all the events, and for me kind of an evolution in my professional life was, how do I impact more people? How do I help more people? And at first I was working one on one, and then it was as a facility manager helping other trainers and coaches get better. And then I was able to scale it up that way. And last year I had an opportunity to join the team over at Natural Force, which is all-natural, nutritional products, and I basically said, “You know what? I’m going to go all in on this because if I can touch a million people through really good, high-quality nutrition, that’s me maximizing my impact and really kind of living my purpose.” So one of the things I wanted to do today is put it out there for anyone listening who maybe uses collagen or MCT oil or whey protein. We really bend over backwards to source the best ingredients in the world, no additives, all that stuff. Everything is as clean as we can possibly make it. It takes a lot of work, working with manufacturers. Kind of like what you were saying, how patients have to know how to talk to their doctor. I don’t think people really realize, and I didn’t realize until I got on the inside, how much work it is for a brand to work with their manufacturers to convince them to get outside of the conventional mold. So it’s the kind of unconventional nutrition is really what we’re pushing here. So I set up a discount code for any Revolution Health listeners. Go to NaturalForce.com, use coupon code “unconventional” and get $10 off plus free shipping on your order. So I just want to put that out there as just a little extra bonus for anybody, and I would certainly love to help in that way and really get some good, high-quality nutrition into people’s hands. Chris:  Awesome. Yeah, and there’s so many ways people can help, and I ... at Paleo f(x) we’ve see the growth of companies that are serving this space, and it's amazing. Like the products that are available now. I had breakfast this morning, I had some eggs and kale and parsley and a little bit of bacon in a couple of cassava flour tortillas. Breakfast burritos. Whoever thought I’d be having a breakfast burrito again? Tortillas are made from completely cassava flour. They’re autoimmune friendly and they’re grain-free tortillas. It’s incredible. Tony:  I think I might have some of those in my fridge as well. Chris:  Yeah. I mean there’s so many things. And these people, they’re serving this movement with that kind of work. So it’s great to see. Tony:  It takes a village, man. Chris:  It does. Thanks again, Tony. I really appreciate it. Thank you, everybody. So again, Kresser.co/bonus to pick up your free audiobook and the other bonuses, and I hope you can all join me in this revolution to reinvent healthcare. We need you, whatever your background and goals. Take care, everybody.

[denisalvney]

RHR: A Three-Step Plan to Fix Conventional Healthcare

In this episode we discuss:

The patient case that inspired the book

Who is this book for?

The mismatch between our medical paradigm and chronic disease

Drug companies and conflicts of interest

How clinicians can help create a new paradigm

The three core problems and how to solve them

What this new paradigm looks like

How do we pay for this? Is it scalable?

How allied providers are the key

Show notes:

Unconventional Medicine by Chris Kresser

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Chris Kresser: Hey, everybody, Chris Kresser here. Welcome to another episode of Revolution Health Radio. Today we’re going to do something a little different. I am bringing on a guest host, Tony Federico, he’s the VP of marketing for Natural Force Nutrition, a physiology editor for the Journal of Evolution and Health, and a longtime contributor to Paleo Magazine, and also at Paleo f(x), which is where I met Tony, I think, originally, and I have interacted with him the most. And he’s moderated several panels that I’ve been on and I’ve always been impressed with the way he’s done that, the intelligent questions that he asks and just his balanced perspective on ancestral health and Functional Medicine, and this movement overall. Today is the day that my new book, Unconventional Medicine, comes out. It’s now available on Amazon, and I wanted to ask Tony to come take over the podcast and talk with me about the book because I know he’s really interested in all these topics and he’s read quite a bit of the book himself, and I thought it would be more interesting to have a conversation about it than for me to just sit here and do a monologue. So Tony welcome to the show and thanks for being here. Tony Federico:  Yeah, thanks for inviting me on, Chris. It’s always fun, when we’ve had the chance to chat, as you said. Whether in person or on podcast, I’m always happy to jump in and dish on health with you. Chris:  Fantastic. So, you have read a little bit of the book and we chatted a little bit about it via email, so let’s dive in. Let’s talk a little bit about this book. And for me it was really, it felt like the most important next step that I could take in order to get this message out about ending chronic disease. Tony:  Yeah, I got my copy of Unconventional Medicine a couple days ago. I just so happened to have some time off yesterday, and the next thing I knew I was 80 pages in. Chris:  Nice. Tony:  So, I have to say that, as somebody who’s been in the trenches, I worked as a personal trainer for 10 years, I could really relate to a lot of the things that you were saying in the book, and we’ll get into why a little bit later on in the interview. But you know I just am really impressed with what you put together here, Chris. So let's just, let's get into it, and the first thing that I actually wanted you to maybe tell me a little bit about was how you open the book, which I think is a really great story about a patient named Leo. So I wanted to talk a little bit about Leo and his story and kind of how that inspired you to go down this particular path of unconventional medicine.

The patient case that inspired the book

Chris:  Sure, yeah. So, Leo was an eight-year-old boy that I treated in my clinic a few years back, and I wanted to start with his story because it's, unfortunately, a typical story, much more common than, of course, we would like. And it was powerful for me, it was a powerful experience. It's what actually led to me writing this book. So, like way too many other kids of his age, he was suffering from a number of behavioral issues. He was initially diagnosed on the autism spectrum. Eventually they settled on OCD and sensory processing disorder. He would throw these just crazy tantrums where he'd end up crying or screaming inconsolably, writhing on the floor, and this would happen for seemingly the simplest of reasons. Like trying to get his shoes tied as they were going out the door, not cutting the crust off his sandwich in just the right way or getting a stain on his favorite T-shirt. And he was really rigid around his behavior and its environment, everything had to be just right, just the way he wanted it to be, or else he would fly off the handle.

Is a new healthcare paradigm affordable? Scalable? You bet.

His diet was extremely limited, he only ate a handful of foods, pretty much all of which were processed and refined. So crackers, bread, toaster waffles, that sort of thing, and this is part of the kind of OCD-like tendencies. And any time his parents would try to introduce new food, he would go totally ballistic. And they were worried about nutrient deficiency, but they didn't feel like they ... they were just worn down. Any parent who has a kid like this will understand that. It's just they didn’t feel like they had the resources to battle him at every meal. And they took him to a bunch of doctors locally, and that’s where they got those diagnoses. Initially they were kind of relieved to have those, but then after a while they realized that they were just simply labels for symptoms. And when they asked what the treatment was, you can probably guess the answer: medication. Tony:  Something to do with drugs. Chris:  Something to do with drugs. Yeah. And when they asked how long he would be on that treatment, you can probably also guess the answer. Tony:  The rest of your life. Chris:  Yeah. Shrug of the shoulders, indefinitely, maybe he'll grow out of it, that sort of thing. And they weren't excited about the idea of of medicating their son, but they were also aware of how much he was suffering, and they were suffering, frankly, too. They decided to give them a try, starting with Adderall, and then they progressed to Ritalin and then antidepressants. And certainly the drugs did seem to help with at least some of the symptoms, but there were a couple issues. Number one, they also caused some very intractable side effects like headache, abdominal pain, irritability, and most significantly, severe sleep disruption. And they had a couple of other kids that were younger than Leo. So they were not happy about the sleep disruption. Nobody was because it was brutal for them and also brutal for Leo. Kids need a lot of sleep, and if they’re waking up throughout the night, that’s going to make ... So that was in some ways worse than the original symptoms they were trying to treat. And then Leo's mom had done quite a bit of research on the effects of these medications and she was scared. Particularly for children and adolescents, some of these drugs have some pretty scary side effects and long-term risks. So what really stood out to me, and I mentioned this in the book, is that not once during this entire process of seeing all these different doctors, primary care provider, psychiatrist, eventually behavioral disorder specialists, did anybody even hint at the possibility that something in Leo's diet or some other underlying issue like a gut problem or nutrient deficiency or heavy metal toxicity or something like that could be contributing to his symptoms. It wasn't even broached as a possibility at any time. Fortunately, Leo's mom, one of her friends followed my work and sent her a couple of articles from my blog. One was on the gut–brain–axis, and I think the other one was on the underlying root causes of behavioral disorders. And so that's what led them to bring Leo to see me, and long story short, we were able to ... we did a bunch of testing, found issues that you might guess at. So, disrupted gut microbiome, SIBO, fungal overgrowth, gluten intolerance, but also intolerance of soy and corn and rice and buckwheat, which were major ingredients in a lot of the processed and refined food products that he ate, and arsenic toxicity because rice milk was the only other beverage he would drink aside from water. And we know that rice products can be high in arsenic. So, we, over several months, it definitely wasn't easy to address these problems because of his OCD-like tendencies and his picky eating habits. But after several months he was like a different kid. His teacher even called home and was like, “What have you done with Leo and who’s this kid that you’re sending in?” Because it was a big issue for her. They often had to come to school and pick him up early because of the behavioral problems. And his diet expanded; he was eating foods he would've thrown against the wall just months before, he was more tolerant of disorder, more relaxed in his environment. They were able to travel for the first time in a long time because he wasn't so anxious in unfamiliar environments. His physical symptoms had improved significantly. So they were just over the moon. They couldn't believe it, and toward the end of our treatment together, she said something that really struck me, which was there’s so many kids out there that are like Leo and they’re suffering, they’re not finding help in the conventional system. Tony:  Sure. Chris:  And their doctors and parents are not even thinking about this stuff. Like it’s not even in most people’s consciousness that if a kid has a behavioral disorder that you should look at these physiological issues. It’s not, for 99 percent of people they don't even go there because they don't know. Tony:  Yeah, I mean I think that that was—reading about Leo and reading about a story and certainly there's people that I've known, myself included, who have had very similar experiences—I think it's great to have a narrative like this that you can really connect to because then when you tease it apart, all the pieces really make sense. It makes sense why having doctors treat symptoms has failed, it makes sense why a lack of communication between the health provider network that was supposed to be serving Leo failed. It makes sense why it didn't work when you actually start to tease it out. But then we’re still all, well not all, but most of us are still going down this path and it's an exercise in futility, really. You have an eight-year-old kid who's on powerful stimulant medications, he’s on antidepressants, and it was bad enough for his parents to reach out and to seek those interventions as solutions, and then the side effects are even worse. And that’s just something that just gets you right in the heart. And like you said, he’s not the only one, he’s not the only kid. His parents are not the only parents. And frankly, his doctors are not the only doctors because I can guarantee you that that probably doesn’t really feel good for the practitioner, for the healthcare provider to not get results as well. And they’re working with what they’ve got. Chris:  Absolutely. Tony:  And trying to use the tools they have. Chris:  Yeah, I mean, let’s be clear about this. Everybody is doing the best they can in this situation. The parents are doing the best they can, in the vast majority of situations, parents just love their kids and do everything possible that they can to help their kids thrive. I’m a parent, I know that that’s how I relate to my kid. I know that every parent I know, that’s how they relate to their kids. And I would even, I would say that’s true for doctors too. The vast majority of them are trying to do the best they can with the tools that they have and in the system that they’re working within. And that’s the rub. Tony:  Right. Chris:   It’s like most doctors I’ve seen have been caring and they’ve wanted to do the right thing, but the question is, can they do the right thing in the conventional medical system as it exists today? And, of course, that’s largely what the book is about.

Who is this book for?

Tony:  Yeah, so let’s kind of speak to that specifically. And we’re talking about doctors, we’re talking about medical professionals, we’re talking about patients, and then we didn’t mention it, but where I fit into this formula or potential formula as an allied healthcare provider, as a personal trainer/health coach, is that your audience for this book, do you really see that kind of triad is who you're speaking to here? Chris:  Yeah, definitely. I think if you look at the cover of the book, the subtitle is “join the revolution to reverse chronic disease, reinvent healthcare, and create a practice you love.” So that last bit would suggest that it's mostly for practitioners, but that's not true. It is really for anybody that is interested in the ideas of reinventing healthcare and reversing chronic disease. And, in fact, I would argue that that change is going to be initiated by people, primarily by people that are not practitioners. So it's like a grassroots, bottom-up approach, where a good example is with my training program, my ADAPT training program, now that we've been training practitioners in this approach for the last couple years, we always ask people how they learned about my work or how they learned about the training program. And in a surprising number of cases, the answer is from their patients. So these doctors or other practitioners, their patient brings an article in that I wrote or brings something in, tells them about me, and to their credit they’re open-minded enough to go and check it out. And then they like what they see and they end up taking the next step. So people even who have no intention of ever becoming a healthcare practitioner, I think would really benefit from this book if they're interested in these ideas. And then certainly, as you mentioned, licensed healthcare providers like medical doctors or nurse practitioners or physician assistants that are currently working within the conventional paradigm but have already seen its limitations and want to do something different but don't yet know what that might look like. And then people who are outside of the conventional paradigm but are already practitioners, so acupuncturists, chiropractors, naturopathic physicians, etc., in many cases they’re already well aware of the limitations of conventional medicine, which is why they chose to go down a different path. But speaking personally as an acupuncturist myself, I also saw some limitations in the traditional Chinese medicine approach, or at least some differences in the way that I wanted to practice it. I was looking for something that could incorporate modern diagnostic testing and create a more systematic approach that included ancestral diet and lifestyle and some of the other things we talk about in the book. So, I think many of those practitioners can benefit from the book from that perspective. And then you have the growing and already large number of people like yourself who are personal trainers, health coaches, nutritionists, etc., who I really think are going to play an increasingly important role in this revolution to reinvent healthcare. Tony:  Yeah, it so important now for people to really, for patients to be their own advocate, and I don't think we’re living in a time where I remember with my grandparents—if your doctor said something, it was basically gospel and you didn’t question it and you didn't think about it. Now, the first thing people do when they experience a symptom, it's Dr. Google first. So it's super important to equip and arm patients with good information, which I think this book does. Here's a path, here's a path forward for you as a patient. But then it's respectful of the role of doctors, and you highlight many situations where conventional medicine is great. If you break your arm or get in a car accident or have a heart attack or whatever the case may be, yeah, you need a doctor, and you need to go to an emergency room and you need those types of interventions. But it's really in this kind of gray area, it’s really not gray, it’s actually quite clear. And we could probably specify a little bit more, but there’s this middle zone where somebody’s not acutely injured, they’re not acutely in a disease state. They’re in a chronic disease state, or they’re just unwell. And it’s hard for a system that is all about pharmacological interventions, surgical interventions, to deal with a more subtle approach. And that’s where that whole middle ground and acupuncturists and massage therapists and everybody who's in that middle zone. I had clients constantly when I was actively training, constantly asking me questions where I was like, you know what? This is really something they maybe should be taking to their doctor. But guess what? The doctor only has 15 minutes under pressure to see as many patients as they can. I had a friend who was a physician in France. And he was telling me about their medical model, and he would spend tons of time with his patients. And it was actually incentivized for prevention. And here we see some maybe misplaced incentives, and perhaps you can speak a little bit more about that.

The mismatch between our medical paradigm and chronic disease

Chris:  Yeah, so, going back to your original comments, I think that the most important thing for people to understand is that our medical model, when it comes to our medical paradigm, is that it evolved during a time when acute problems were the biggest issues. So in 1900, the top three causes of death were all infectious diseases, tuberculosis, typhoid, and pneumonia. And the other reasons people would see the doctor were among those you mentioned, like a broken bone or a gallbladder attack or appendicitis. Tony:  War. Chris:  Right, injuries, trauma, etc. And so the treatment for that's pretty straightforward. It wasn't always successful, of course, but it was straightforward. You know, if the bone was broken, you set it in a cast. If the gallbladder was swelling, you would take it out. If someone was having appendicitis, you’d remove the appendix. So that's pretty ... it's one problem, one doctor, one treatment. Pretty straightforward. But you fast-forward to today, it's a totally different healthcare landscape. Seven of the top 10 causes of death are chronic disease rather than acute problems now, and 86 percent of the healthcare dollars we spend go toward treating chronic disease. And unlike acute problems, chronic diseases are expensive, difficult to manage and usually last for a lifetime. They don't lend themselves to that one doctor, one problem, one treatment kind of approach. The average chronic disease patient requires multiple doctors, usually one for every different part of the body in our system, and is taking ... Tony:  Specialists. Chris:  Right, specialists, they’re taking multiple medications in many cases, and they're going to be taking those medications for the rest of their life. So far, it's really, our conventional medical system is amazing for these acute problems. But it's the wrong tool for the job for chronic problems. So that's one issue, and it’s really important to point that out, because we just went through the whole healthcare debate again with the Affordable Care Act and the current administration’s proposal for a replacement, which has not come to fruition. But throughout that entire discussion, it really bothered me that there was an elephant in the room. All the discussion was around insurance. Like, who gets insurance and who doesn’t. And that’s important, it’s important to talk about that. But we have to recognize that health insurance is not the same thing as healthcare. Tony:  Yeah. Chris:  Health insurance is a method of paying for healthcare. And that’s really crucial to get that difference. Because my argument in the book is that there is no method of paying for healthcare, whether it’s the government, corporations, or individuals, that will be adequate and will be sustainable under the pressure of growing prevalence of chronic disease. It will bankrupt all of us. Government, the corporations, individuals, whoever is responsible for paying for the care will not be able to do it unless we can actually prevent and reverse chronic disease instead of just slapping Band-Aids on it. Tony:  I think the analogy you gave in the book was rearranging the deck chairs on the Titanic. “Making a few small tweaks to our current system and expecting that to work is like rearranging the deck furniture on the Titanic as it inexorably sinks into the ocean. Too little, too late.”  Chris:  Yeah, exactly. That’s the argument about insurance. As the whole ship goes under, sinks under. The other problems you mentioned are very real also. So we have a misalignment of incentives, like the insurance industry, for example, doesn't benefit when the cost of care shrinks because they only make more money when the overall expenditures rise. So it's actually not in their best interest necessarily to seek out the most cost-effective solutions.

Drug companies and conflicts of interest

Chris: And then of course, we have drug companies. People are pretty well aware of the conflicts of interest there. It’s in their interest to sell drugs, and even when that’s not in the interests of the general public or the patients or the doctors. In many cases, it’s not in their interest either. So the best example of this is a recent one. We’re in the midst of an opioid crisis, the worst we’ve ever seen by far, and the DEA has been wanting to create new regulations that restrict a pharmacy’s ability to sell opioids in ways that will protect people. So, for example, there was a pharmacy in West Virginia in a town that was tiny. It had like 30,000 people in this town, and they had ordered something like nine million opioid pills in the last year. It was clearly a front, like there’s clearly something shady going on there. There's no way that 30,000 people in that town needed nine million opioid pills, and yet there are no regulations to actually prevent that from happening. And so, the DEA had proposed some regulations to just safely protect people from that kind of thing. And the Big Pharma lobby basically shut that down and they played a big role in writing a law that limits the DEA's ability to do that kind of regulation in the midst of the worse opioid crisis ever. And to put this in perspective, we hear a lot about the gun lobbies and their control. They spend about $10.5 million lobbying Congress, I think, per year. And Big Pharma, they spent $250 million. Tony:  Wow. Chris:  Twenty-five-fold higher. Tony:  It's really tragic. I actually, I don’t think we’ve ever talked about this, but I grew up in South Florida, which was kind of ground zero for the opioid epidemic. And I remember in high school down in Miami and West Palm Beach, and kids would get a hold of a contact or whatever, somebody that had a prescription and basically would end up being a de facto drug dealer vis-à-vis a pill mill, etc. The kid across the street from me died, multiple kids in my high school died, multiple kids went into in-treatment programs, some of them battled addictions for decades. Some of them got out of it. Very few got out of it. Some of them didn't and have continued to be plagued with either switching from pharmaceuticals to street drugs like heroin, etc., and then we can see what's happening there. And that's just one example. If we look at drug consumption in the United States, is it that Americans are just that much sicker and we’re in that much more pain than people in other countries? Because we’re consuming far and away more painkillers than any other country on the planet. And I would venture to guess that you could say the same about antidepressants or ADD medication. It's very much a case of misaligned incentives. And incentives are working in the sense of the pharmaceutical companies are doing very well. Chris:  Yeah. Who are they working for is the question. Tony:  Exactly. Chris:  We’re the only country aside from New Zealand that allows direct-to-consumer drug advertising, and I think that's a big part of the problem. But it's not just Big Pharma. We also have conflicts in medical research that, of course, are related to Big Pharma because they pay for two-thirds of all medical research. We have broken payment models, where there's no real incentive or reward for good performance, and in fact, you could argue it's the other way around because doctors are compensated for, usually based on the number of procedures they order and the number of patients they see. So to your point about the doctor in France who is actually incentivized to prevent, rather than just treat disease, we don't have that at all, it's the opposite. And so there are a lot of deeply entrenched issues that we certainly need to address, and that's not essentially what this book is about. There are other books that cover that material really well, and frankly many of those issues are outside of our individual control as clinicians or practitioners.

How clinicians can help create a new paradigm

Chris: We can work toward addressing them, and I think we should, but the good news is that I think that the bigger changes that we need to focus on individually and collectively are addressing the medical paradigm which we’ve talked about, creating a medical paradigm that’s better suited to tackle chronic disease. Addressing the mismatch between our modern diet and lifestyle, and our genes and our biology, which we've, of course, talked a lot about on the show before. And then creating a new way of delivering healthcare that actually supports this new medical paradigm and this more preventative approach. Because those things are all within our control as clinicians. Tony:  Yeah. I like how you posed the question, and it was kind of a cool little, I think it was, not Hiroshi, but the person who is in charge of cooking at a Buddhist monastery. And basically a young monk comes up to this older man. He’s like, why are you doing the grunt work, basically washing rice out in the courtyard? And he says, it was like, what was it? “If not me, who? And if not now, when?” And I think that that’s really kind of the core of setting all this stuff up. Talking about the problem is really in the service of pivoting to the solution, and I’m a big believer in thinking globally, thinking big, but acting locally, hyper-locally, like yourself. Chris:  Yeah. Tony:  And then the people around you and who you can touch and impact. That’s ultimately where the power comes from. So let’s talk about that. What is in people’s power. And you started to describe some of those pillars of a new model. And you describe it as the ADAPT framework. And I don’t know how much you get into this on your regular podcast episodes, but to just kind of lay it out, ADAPT from a big-picture perspective. How does that actually address some of these systemic issues from an individually empowered stance? Chris:  Yeah, great question, and before I even go into that, I just want to say I agree that I think the change is going to happen on different levels. So, because a lot ... we’ve talked about this stuff at conferences or even some people who’ve already read the book. They say, oh, this is fantastic. I’m so excited. But how are we going to deal with Big Pharma and the insurance industry and these misaligned incentives and all of that? And can we ever deal with that? The answer is we’re not going to deal with that overnight and it’s going to take a while to unwind those things. Tony:  It’s the chronic disease, is what you call... Chris:  Exactly, exactly. And I use that analogy in the book. But the good news is that changes can happen very quickly on an individual and local level. And there’s already a lot of evidence of that happening. So my own clinic, CCFM, tripled in size in the last three years alone. We have Cleveland Clinic Center for Functional Medicine, launched by Dr. Mark Hyman, has just blown up like crazy. I mean they started in this tiny space. Now their 17,000-square-foot space, it takes up the whole second floor of the Glickman Tower at Cleveland Clinic. They've got a waitlist of 2,500 patients from nine countries around the world. This is really exciting! The Cleveland Clinic is always on the forefront of the newest trends in medicine, and the fact that they've invested that much money in this speaks volumes. Then we have groups like Iora Health, an organization based in the Rocky Mountain area that’s reversing diabetes using health coaches. So there are lots of really interesting produced concepts, and there's going to be more and more of these. Like we’re doing a pilot program with the Berkeley Fire Department where we’re working with their new recruits to help, we’re implementing a wellness program. Tony:  That’s awesome. Chris:  To reduce injuries and help with recovery and optimize their performance. And if that goes well, there’s been interest from the wider fire department and in the city of Berkeley as a whole. Robb Wolf’s done some incredible work with Reno that we’ve talked about before. So I think the change is going to happen more quickly on this local grassroots level, and then that's going to start to get the attention of people on a state and federal level. And then it will start to get really interesting.

The three core problems and how to solve them

To answer your question, in my book I basically lay out three core fundamental problems with the healthcare system in the US. And these, I argue, go even deeper than the misaligned incentives and Big Pharma and all of that stuff, although they’re, of course, connected. The first is that there is a profound mismatch between our genes and our biology and our modern diet and lifestyle. And I'm not going to say more about that now because almost everyone listening to this podcast knows exactly what I mean. The second problem is the mismatch between our medical paradigm and chronic disease, which we just talked about. We need a new medical paradigm that is better suited for chronic disease. And then the third is that the way we deliver care in this country is also, it's not set up to support the most important interventions. And we’ve touched on that too, where the average visit with the primary care provider is just actually eight to 12 minutes. Tony, you were talking about 15 minutes. That’s luxurious in our current model. The average amount of time a patient gets to speak before they’re interrupted by the doctor is 12 seconds. Tony:  Wow. Chris:  So I think it’s pretty clear that if a patient has multiple chronic diseases, which one in four Americans now do, one in two has one chronic disease, and they show up to the doctor’s office and they're on multiple medications, and they had been presenting with a whole set of new symptoms, there’s absolutely no way to provide high-quality care in a 10-minute visit. So we have to change our, not only the paradigm, but also the way that care is delivered. So that was my premise. So it follows then that my solution would address, I would hope at least those three points, right? Each of those three deficiencies. So the ADAPT framework combines an ancestral diet and lifestyle, which addresses that mismatch between our genes and biology in our modern diet and lifestyle. And then Functional Medicine is the new paradigm of medicine that is based on addressing the root cause of health problems, so we can prevent and reverse them instead of just suppressing symptoms. And then the third component is what I call a collaborative practice model, which links licensed providers like medical doctors, nurse practitioners, with what I call allied providers, which include folks like yourself, Tony, health coaches, nutritionists, personal trainers, etc., to provide a much, much higher level of care than what doctors are able to provide on their own. So, again, we're not trying to replace doctors in any, or even conventional medicine. We need people to do colonoscopies and remove cancerous tumors and use all of the incredible amount of training and expertise and skill that they’ve acquired over a lifetime of practice and study. We absolutely want that, but we need to add stuff to that that's not available now. Tony:  What that really says to me is, emphasize the importance of community, of connection, of collaboration. We’re social creatures, we’re tribal by nature. That’s another kind of Paleo/ancestral health part of the puzzle. And it would be foolish to think that we can dissect out and silo out all these different aspects of our lives without consequence. I really like this idea of bringing everybody into the fold, and it’s not saying that you can go to just the naturopath, or you can go to just the health coach. Because like I mentioned already, I certainly would’ve been ill-equipped to handle plenty of issues that a client would’ve brought to mind or brought up in conversation during a training session. But it would’ve been really great to say, ah, here's the Functional Medicine practitioner that I recommend you speak with, and to have a good relationship with that person and to be able to, as a health coach, help my clients better by getting them in touch with the right person. And that’s having this network that can really support people throughout their health journey whether it’s just feeling better and more energy, or addressing something like diabetes or hypertension. Which certainly there’s a place for all the players in that kind of scenario.

What this new paradigm looks like

Chris:  Absolutely. And let’s use an example just to bring this to life for people. So, imagine you go to the doctor and they do some blood testing for your annual physical. And they find that your fasting blood sugar is 96 or 97. Your hemoglobin A1c is 5.5, and you’ve got triglycerides that are 110, 120, maybe 130. Currently, what would happen is nothing, usually. Tony:  You’re not sick enough yet. Chris:  Yeah, all of your markers are within the lab range, they say, and that means you’re normal, and so you might get some vague advice about make sure to exercise and follow a good diet. And thank you very much, that’s it. Certainly there are exceptions to the rule, of course. There’s some practitioners who can get a lot more proactive about that. But I can’t tell you how many people, patients I’ve had that have been given that basic line with those kinds of lab results. What could happen is this. The doctor says, “Well, you know, if we think of blood sugar disorders on a spectrum, on the left you’ve got perfect blood sugar. On the right you’ve got full-fledged type 2 diabetes. You’re not on the right yet, you don’t have type 2 diabetes or even technically prediabetes, but you’re progressing along that spectrum. And what we know from a lot of research is that if we don’t intervene now, that you’re going to continue progressing. And in fact, we have studies that show that the average patient who has prediabetes, will progress to full-fledged type 2 diabetes in just five years if it’s not addressed.” So what we want to do is be proactive here. We want to intervene now because it’s much easier to prevent a disease before it occurs than it is to treat it after it’s already occurred. So here’s what we’re going to do. We’re going to set you up with our staff health coach, and they’re going to give you all the support you need to adopt a better diet. They’re actually even going to take you shopping, they’re going to come to your house and clean out your pantry with you, and they're going to give you recipes and meal plans and give you ... totally hold your hand and do everything that they need to to get you on this diet. Because we know that information is not enough. We’ve got lots of studies. I can tell you as a doctor, go eat a healthy diet, and hey, we know that that’s probably not going to happen. Most people know what they should be doing, but they’re not doing it, and it’s not because of lack of information. It’s because they need support, and we’re here to support you. We’ve got this health coach. Furthermore, we've got this great personal trainer named Tony. We’re going to set you up with him and we’re also going to set you up with a gym membership. And the good news is, your insurance is going to pay for all this. They’re going to pay for the health coach, they’re going to pay for the gym membership, they’re going to pay for your sessions with Tony. And in six months’ time, you’re going to come back here and we’re going to retest your blood markers and I can almost guarantee that if you stick with the program, you’re going to have normal blood sugar by that time. And throughout that period you’re going to have weekly check-ins with a health coach, you’re going to have training sessions. And not only will your blood sugar be normal, you’re going to lose weight, your energy levels are going to go up, your sleep’s going to get better, you’re going to feel more confident and empowered because you’re making these changes, and you’re going to feel like a different person. Now that’s totally possible.

How do we pay for this? Is it scalable?

Chris: I can hear some people saying, “Oh, how are we going to pay for that? That’s ridiculous.” Tony:  Is it scalable? Chris:  The question we should be asking is, is treating type 2 diabetes scalable? Because I mentioned this in the book, it costs $14,000 a year to treat a single patient with type 2 diabetes. So let’s imagine that this patient progresses. We don’t intervene, five years later they have type 2 diabetes. All of a sudden the healthcare system is spending $14,000 a year paying for that person’s care. And let’s say that that person gets diagnosed at age 40, which is still reasonable these days. The age of diagnosis is dropping more and more, and then let’s say that they live until they’re 85 years old, which is also possible because of our heroic medical interventions that keep people alive a lot longer than they might have been otherwise. So 45 years living with type 2 diabetes, that’s a cost of almost $650,000 for one patient to the healthcare system. Tony:  And that doesn’t even touch on the lost wages, cost to employers, when someone’s on leave, loss of productivity. And then the cost to the family members. Chris:  Absolutely. Tony:  People that are actually, are helping the patient, their health is going to be going down too. Chris:  Yeah. Nor does it touch on the qualitative aspects. Being immobilized, not being able to play with your grandkids, all of that stuff. But let’s just even forget about that for a second—$650,000, okay? And then the CDC recently came out with statistics saying that 100 million Americans have either prediabetes or diabetes, and 88 percent of people with prediabetes don’t even know that they have it. Which means they're almost certainly going to progress, right? If you do the math and you multiply 100 million people times even $14,000 for one year, you get a number that’s so large, I don’t even know what it is. It’s like a google something. It’s like, it has so many zeros after it, I don’t even know how to characterize it. But then if you multiply 100 million times like 20 or 30 years, it’s more money than there is in the world. It's like it's not going to happen. Tony:  Not sustainable, not scalable. Chris:  Not sustainable, not scalable. So let’s say in our example that we ... the healthcare system spends $10,000, which is way more than would be necessary, but let’s even say we buy the person’s groceries for three months. And their gym membership and their trainer, and their health coach, and those weekly, let’s say we spend $10,000. We’re just super generous and we spend $10,000 for that six-month period. Again, the research and my clinical experience indicates with near certainty that if the person is at that stage of not even prediabetic and we intervene, there’s like almost no chance that it’s not going to, we’re not going to be able to normalize that person’s blood sugar. And if they do that and they stick with it and they are able to do that because they now have support rather than just information, we’ve just saved the healthcare system $640,000 over the course of that patient’s lifetime. And that’s a conservative estimate, as you say. We're not including even the indirect costs. Tony:  Right, right. Chris:  I think that this is not only possible, it's going to become necessary. And whether we get there with a proactive approach where we decide to move in this direction and we make these changes or whether we get there because we absolutely have no choice, we’re going to get there. Tony:  Yeah. I mean it really sounds like we can’t afford to not do this. Chris:  Exactly. Tony:  And if we get to that point where we continue down the reactive path and we wait until there’s a total collapse, it might be too late, just to put it frankly. And it’s going to come out at a huge, not just financial cost, a huge human cost. Chris:  Yeah, it’s going to be, we can use the chronic disease metaphor again, it’s a lot easier to prevent a problem or reverse it at an earlier stage than it is to wait until the patient is essentially on life support or the healthcare system is on life support. It’s harder to reverse it at that time. And that’s of course why I’m writing the book now because I want to get this message out as far and wide as I can. Tony:  Yeah. If not now, when? If not you, who? Go right back to there.

How allied providers are the key

Chris:  Exactly. And one more thing about that is the amazing thing, the beauty of this is that it takes about eight years and hundreds of thousands of dollars to train a doctor. And it takes a certain kind of personality and a certain kind of comfort level with science, and a lot of prerequisites. It’s not for everybody. And there’s a ... already we have a shortage of doctors, and that’s predicted to get worse. I’ve seen estimates that suggest by 2025 we’ll have a shortage of 52,000 primary care physicians. So that’s a big deal. [insert image] So we already don’t have enough doctors, it’s already going to get worse, but if you think of healthcare as like a ... I have something in the book called the healthcare population pyramid. And you were referring to it earlier, Tony, where at the very top of that pyramid you’ve got 5 percent of people who are in really acute situations. So they’re in the hospital or they’re in an intensive outpatient care setting. They need the conventional medicine paradigm as it exists, and it’s fantastic for those situations. Then you’ve got another 25 percent of people in that kind of high middle of the pyramid who are dealing with some pretty serious chronic health challenges. So they require more regular care, but they’re not sick enough to be in the hospital or in any kind of ... they’re living their lives, but they’re struggling a lot. A Functional Medicine practitioner/clinician usually working in concert possibly with the conventional specialist of some kind is a really great option for that 25 percent of the pyramid. But then you’ve got the 70 percent at the bottom. So these are people who do, may have health issues, but they’re more minor, so they might have skin problems, or a little bit of brain fog, some difficulties sleeping, some GI issues. And these can be definitely debilitating and total pain, but they’re not at the level of that 25 percent. My argument is that in many cases these people could be very well served by a health coach or nutritionist with good training. And possibly seeing a Functional Medicine provider once or twice a year, or something like that. And the thing is, we can train people in a year or two without an extensive science background to be very, very objective in this role. Because they’re mostly working with patients on changing their behavior. If you think about it, most of the risk factors for chronic disease come down to the wrong behaviors. Eating the wrong diet, not getting enough sleep, not exercising, or exercising too much, or any number of things that come down to choices that we’re making. And so if a skilled health coach who’s trained in things like motivational interviewing and coaching to strengths and other evidence-based principles of facilitating behavior change which we have a ton of research on, they can be incredibly effective for that 70 percent of the population. That's the majority of the population. So we’re totally underutilizing these practitioners, and my argument is that they’re going to play a huge role in this future of medicine. And that's of course one reason why we're launching an ADAPT Health Coach Training Program next year to complement the practitioner training program that we've been doing. Because I want to create this ecosystem we've been talking about where you have all of these different types of practitioners working to the maximum of their training and ability and scope of practice and supporting each other and therefore providing the highest level of care to patients. Tony:  That certainly kind of perks my ears up hearing about the ADAPT health coach option and something that I’m personally interested in. So who knows? Maybe I can get in on that. We can talk about it again in the future. Chris:  Yeah, for sure. For sure. Tony:  So, for this particular book, for Unconventional Medicine, people are fired up, they’re hearing about it, they’re like, “Okay, this resonates with me. I’m a practitioner, I’m an allied health provider, I’m a patient, I’m ready. Now’s the time. This is it. We’re going to do this.” What’s the best way for people to get their hands on this thing? Chris:  Well not surprisingly, Amazon. They have the best way to get your hands on anything. So it’s available in paperback, Kindle, and audiobook. We’re hoping [the audiobook] is going to be out today, the day this podcast is released. But it might be another two or three days. They’re just taking their sweet time to approve it. I narrated the audiobook myself. So you podcast listeners, I figured you might be into that, since you like to listen. Tony:  They know your voice. Chris:  Yeah, and just listening to something instead of reading it perhaps. So to that end, we have a special offer for podcast listeners, because I appreciate your support and I know many of you are already part of this movement, and some are wanting to get involved. So if you buy that paperback or Kindle version between now and Sunday night, you’ll get some really cool bonuses. The first is a free copy of the audiobook. So again, we wanted to include that for podcast listeners, since we figured you guys and gals are probably interested in audio. But there are two other things that are really, I think, fantastic. And one, they’re both tools to help you be more confident and persuasive and factual when you share your passion for Functional Medicine and an ancestral diet and lifestyle. Because we’ve had a lot of questions from people, both practitioners and non-practitioners alike. They say, “Oh, how do I talk about this stuff to my sister at Thanksgiving?” Tony:  “Isn’t that that caveman diet?” Chris:  Yeah, exactly. All of our ancestors died when they were 30, so why should we even care? How do you respond to those arguments? Or if you start talking about Functional Medicine and maybe one of your conventional medicine colleagues says, “Oh, that’s just, I saw something on Science-based Medicine that said that was all just hooey. There’s nothing to it. How do you respond to that?” So what we wanted to do is give people the ammunition they needed in a respectful way. You know, this isn’t about getting the better of somebody. It’s about responding in a factual and convincing but respectful way. So we’ve got two different, we’re calling these the Power Packs. And one is for practitioners, so clinicians, health coaches, nutritionists, trainers, etc., and these are facts, research that you can reference and persuasive reasons for your clients or patients or colleagues to consider this Functional Medicine and ancestral diet and lifestyle approach. And then we have one for non-practitioners called the Supporter Power Pack. And these are smart answers and compelling comebacks, again respectful, for those common objections that you hear when you start talking about this stuff with your friends and family. So these bonuses are available until Sunday night [November 12, 2017] at 11:59 p.m. Pacific Time. So you’ve got a few days to act on that, and you can go to ... we set up a special link for you to get these and that’s Kresser.co/bonus. That’s Kresser.co/bonus. So head over there to get your Power Packs and your free audiobook, and that’s after you purchase either the paperback or Kindle. There’ll be a place where you enter your order number and we ask for some information just to verify, and I hope you enjoy those and get a lot out of them. Because they were actually really fun to put together. Tony:  Yeah, I think the audiobook is huge. I like to listen to audiobooks when I’m driving around town or outside getting some exercise. Chris:  Yeah. Tony:  So, no excuses when you make it that easy. Chris:  Yeah, yeah. So, Tony, thanks so much for doing this. This has been really fun to talk to you, as it always is. And I appreciate it. Tony:  Actually, I wanted to throw in one extra little special thing, as we mentioned, at the top of the show. I spent 10 years as a personal trainer in the trenches, I was involved with Paleo Magazine for many, many years, going to all the events, and for me kind of an evolution in my professional life was, how do I impact more people? How do I help more people? And at first I was working one on one, and then it was as a facility manager helping other trainers and coaches get better. And then I was able to scale it up that way. And last year I had an opportunity to join the team over at Natural Force, which is all-natural, nutritional products, and I basically said, “You know what? I’m going to go all in on this because if I can touch a million people through really good, high-quality nutrition, that’s me maximizing my impact and really kind of living my purpose.” So one of the things I wanted to do today is put it out there for anyone listening who maybe uses collagen or MCT oil or whey protein. We really bend over backwards to source the best ingredients in the world, no additives, all that stuff. Everything is as clean as we can possibly make it. It takes a lot of work, working with manufacturers. Kind of like what you were saying, how patients have to know how to talk to their doctor. I don’t think people really realize, and I didn’t realize until I got on the inside, how much work it is for a brand to work with their manufacturers to convince them to get outside of the conventional mold. So it’s the kind of unconventional nutrition is really what we’re pushing here. So I set up a discount code for any Revolution Health listeners. Go to NaturalForce.com, use coupon code “unconventional” and get $10 off plus free shipping on your order. So I just want to put that out there as just a little extra bonus for anybody, and I would certainly love to help in that way and really get some good, high-quality nutrition into people’s hands. Chris:  Awesome. Yeah, and there’s so many ways people can help, and I ... at Paleo f(x) we’ve see the growth of companies that are serving this space, and it's amazing. Like the products that are available now. I had breakfast this morning, I had some eggs and kale and parsley and a little bit of bacon in a couple of cassava flour tortillas. Breakfast burritos. Whoever thought I’d be having a breakfast burrito again? Tortillas are made from completely cassava flour. They’re autoimmune friendly and they’re grain-free tortillas. It’s incredible. Tony:  I think I might have some of those in my fridge as well. Chris:  Yeah. I mean there’s so many things. And these people, they’re serving this movement with that kind of work. So it’s great to see. Tony:  It takes a village, man. Chris:  It does. Thanks again, Tony. I really appreciate it. Thank you, everybody. So again, Kresser.co/bonus to pick up your free audiobook and the other bonuses, and I hope you can all join me in this revolution to reinvent healthcare. We need you, whatever your background and goals. Take care, everybody. RHR: A Three-Step Plan to Fix Conventional Healthcare published first on https://chriskresser.com

[mindocr]

Generation Adderall

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Chad Wys. Source image from the Getty’s Open Content Program. “Portrait of a Woman,” by Jacob Adriaensz Baker. Generation Adderall Like many of my friends, I spent years using prescription stimulants to get through school and start my career. Then I tried to get off them. BY CASEY SCHWARTZOCT. 12, 2016 Have you ever been to Enfield? I had never even heard of it until I was 23 and living in London for graduate school. One afternoon, I received notification that a package whose arrival I had been anticipating for days had been bogged down in customs and was now in a FedEx warehouse in Enfield, an unremarkable London suburb. I was outside my flat within minutes of receiving this news and on the train to Enfield within the hour, staring through the window at the gray sky. The package in question, sent from Los Angeles, contained my monthly supply of Adderall. Adderall, the brand name for a mixture of amphetamine salts, is more strictly regulated in Britain than in the United States, where, the year before, in 2005, I became one of the millions of Americans to be prescribed a stimulant medication. The train to Enfield was hardly the greatest extreme to which I would go during the decade I was entangled with Adderall. I would open other people’s medicine cabinets, root through trash cans where I had previously disposed of pills, write friends’ college essays for barter. Once, while living in New Hampshire, I skipped a day of work to drive three hours each way to the health clinic where my prescription was still on file. Never was I more resourceful or unswerving than when I was devising ways to secure more Adderall. Adderall is prescribed to treat Attention Deficit Hyperactivity Disorder, a neurobehavioral condition marked by inattention, hyperactivity and impulsivity that was first included in the D.S.M. in 1987 and predominantly seen in children. That condition, which has also been called Attention Deficit Disorder, has been increasingly diagnosed over recent decades: In the 1990s, an estimated 3 to 5 percent of school-age American children were believed to have A.D.H.D., according to the Centers for Disease Control and Prevention; by 2013, that figure was 11 percent. It continues to rise. And the increase in diagnoses has been followed by an increase in prescriptions. In 1990, 600,000 children were on stimulants, usually Ritalin, an older medication that often had to be taken multiple times a day. By 2013, 3.5 million children were on stimulants, and in many cases, the Ritalin had been replaced by Adderall, officially brought to market in 1996 as the new, upgraded choice for A.D.H.D. — more effective, longer lasting. Continue reading the main story Advertisement Continue reading the main story Adderall’s very name reflects its makers’ hopes for an expanding customer base: “A.D.D. for all” is the phrase that inspired it, Alan Schwarz writes in his new book, “A.D.H.D. Nation.” And in fact, by the time I arrived at college in 2000, four years after Adderall hit the market, nearly five million prescriptions were written; in 2005, the year after I graduated, that number was just under nine million. By then, sales of A.D.H.D. medication in the United States totaled more than $2 billion. Sign Up for the Magazine Newsletter Get the best of the Magazine delivered to your inbox every week, including exclusive feature stories, photography, columns and more. Sign Up Receive occasional updates and special offers for The New York Times's products and services. SEE SAMPLE MANAGE EMAIL PREFERENCES PRIVACY POLICY By the mid-2000s, adults were the fastest-growing group receiving the drug. In 2012, roughly 16 million Adderall prescriptions were written for adults between ages 20 and 39, according to QuintilesIMS, an information-and-technology-services company that gathers health-care-related data. Adderall has now become ubiquitous on college campuses, widely taken by students both with and without a prescription. Black markets have sprung up at many, if not most, schools. In fact, according to a review published in 2012 in the journal Brain and Behavior, the off-label use of prescription stimulants had come to represent the second-most-common form of illicit drug use in college by 2004. Only marijuana was more popular. We know very little about what Adderall does over years of use, in and out of college, throughout all the experiences that constitute early adulthood. To date, there is almost no research on the long-term effects on humans of using Adderall. In a sense, then, we are the walking experiment, those of us around my age who first got involved with this drug in high school or college when it was suddenly everywhere and then did not manage to get off it for years afterward — if we got off it at all. We are living out what it might mean, both psychologically and neurologically, to take a powerful drug we do not need over long stretches of time. Sometimes I think of us as Generation Adderall. Adderall as we know it today owes its origins to accident. In the late 1920s, an American chemist named Gordon Alles, searching for a treatment for asthma, synthesized a substance related to adrenaline, which was known to aid bronchial relaxation. Alles had created beta-phenyl-isopropylamine, the chemical now known as amphetamine. Injecting himself to test the results, he noted a “feeling of well being,” followed by a “rather sleepless night,” according to “On Speed: The Many Lives of Amphetamine,” by Nicolas Rasmussen. By the 1930s, the drug Benzedrine, a brand-name amphetamine, was being taken to elevate mood, boost energy and increase vigilance. The American military dispensed Benzedrine tablets, also known as “go pills,” to soldiers during World War II. After the war, with slight modification, an amphetamine called Dexedrine was prescribed to treat depression. Many people, especially women, loved amphetamines for their appetite-suppressing side effects and took them to stay thin, often in the form of the diet drug Obetrol. But in the early 1970s, with around 10 million adults using amphetamines, the Food and Drug Administration stepped in with strict regulations, and the drug fell out of such common use. More than 20 years later, a pharmaceutical executive named Roger Griggs thought to revisit the now largely forgotten Obetrol. Tweaking the formula, he named it Adderall and brought it to market aimed at the millions of children and teenagers who doctors said had A.D.H.D. A time-release version of Adderall came out a few years later, which prolonged the delivery of the drug to the bloodstream and which was said to be less addictive — and therefore easier to walk away from. In theory. The first time I took Adderall, I was a sophomore at Brown University, lamenting to a friend the impossibility of my plight: a five-page paper due the next afternoon on a book I had only just begun reading. “Do you want an Adderall?” she asked. “I can’t stand it — it makes me want to stay up all night doing cartwheels in the hallway.” Could there be a more enticing description? My friend pulled two blue pills out of tinfoil and handed them to me. An hour later, I was in the basement of the library, hunkered down in the Absolute Quiet Room, in a state of peerless ecstasy. The world fell away; it was only me, locked in a passionate embrace with the book I was reading and the thoughts I was having about it, which tumbled out of nowhere and built into what seemed an amazing pile of riches. When dawn came to Providence, R.I., I was hunched over in the grubby lounge of my dormitory, typing my last fevered perceptions, vaguely aware that outside the window, the sky was turning pink. I was alone in my new secret world, and that very aloneness was part of the great intoxication. I needed nothing and no one. I would experience this same sensation again and again over the next two years, whenever I could get my hands on Adderall on campus, which was frequently, but not, I began to feel, frequently enough. My Adderall hours became the most precious hours of my life, far too precious for the Absolute Quiet Room. I now needed to locate the most remote desk in the darkest, most neglected corner of the upper-level stacks, tucked farthest from the humming campus life going on outside. That life was no longer the life that interested me. Instead, what mattered, what compelled, were the hours I spent in isolation, poring over, for instance, Immanuel Kant’s thoughts on “the sublime.” It was fitting: This was sublime, these afternoons I spent in untrammeled focus, absorbing the complicated ideas in the texts in front of me, mastering them, covering their every surface with my razor-like comprehension, devouring them, making them a part of myself. Or rather, of what I now thought of as my self, which is to say, the steely, undistractable person whom I vastly preferred to the lazier, glitchier person I knew my actual self to be, the one who was subject to fits of lassitude and a tendency to eat too many Swedish Fish. Adderall wiped away the question of willpower. Now I could study all night, then run 10 miles, then breeze through that week’s New Yorker, all without pausing to consider whether I might prefer to chat with classmates or go to the movies. It was fantastic. I lost weight. That was nice, too. Though I did snap at friends, abruptly accessing huge depths of fury I wouldn’t have thought I possessed. When a roommate went home one weekend and forgot to turn off her alarm clock so that it beeped behind her locked door for 48 hours, I entirely lost control, calling her in New York to berate her. I didn’t know how long it had been since I’d slept more than five hours. Why bother? By my senior year of college, my school work had grown more unmanageable, not less. For the first time in my life, I wasn’t able to complete it. My droll, aristocratic Russian-history professor granted me an extension on the final term paper. One Friday evening well into December, when the idyllic New England campus had already begun to empty out for winter break, I was alone in the Sciences Library — the one that stayed open all night — squinting down at my notes on the Russian intelligentsia. Outside, it was blizzarding. Inside, the fluorescent lights beat down on the empty basement-level room. I felt dizzy and strange. It had been a particularly chemical week; several days had passed since I had slept more than a handful of hours, and I was taking more and more pills to compensate. Suddenly, when I looked up from the page, the bright room seemed to dilate around me, as if I weren’t really there but rather stuck in some strange mirage. I seized with panic — what was happening? I tried to breathe, to snap myself back into reality, but I couldn’t. Shakily, I stood and made my way toward the phones. I dialed my friend Dave in his dorm room. “I’m having some kind of problem in the Sci Li,” I told him. My own voice sounded as if it belonged to someone else. An hour later, I was in an ambulance, being taken through the snowstorm to the nearest hospital. The volunteer E.M.T. was a Brown student I’d met once or twice. He held my hand the whole way. “Am I going to die?” I kept asking him. Dave and I sat for hours in the emergency room, until I was ushered behind a curtain and a skeptical-looking doctor came in to see me. I wasn’t used to being looked at the way he was looking at me, which is to say, as if I were potentially insane, certifiable even. By then, I was feeling a little better, no longer so sure I was dying, and as I lay down on the examination table, I joked to him, “I will recline, like the Romans!” His expression remained unamused. I described what I’d been taking. His diagnosis: “Anxiety, amphetamine induced.” I had had my first panic attack — an uncommon but by no means unknown reaction to taking too much Adderall. When I left the hospital, I left behind the canister of blue pills that I had painstakingly scrounged together. I still remember the sight of it sitting next to the examination bed. Photo Credit Illustration by Chad Wys. Source image from the Getty’s Open Content Program. “Portrait of Louise de Keroualle, Duchess of Portsmouth,” by Peter Lely. A few days later, I drew incompletes in my classes and went back home to New York. My father knew about the hospital incident, but I promised him I would stop taking the drug. And I fully intended to. I spent that long winter break at the public library on 42nd Street, soldiering lethargically through the essays I hadn’t been able to cope with while taking amphetamines. What I didn’t know then, what I couldn’t have known, was that the question of whether Adderall actually improves cognitive performance when taken off-label — whether or not it is a “smart drug” — was unresolved. It would be another few years before studies appeared showing that Adderall’s effect on cognitive enhancement is more than a little ambiguous. Martha Farah, a cognitive neuroscientist at the University of Pennsylvania, has conducted much of this research. She has studied the effect of Adderall on subjects taking a host of standardized tests that measure restraint, memory and creativity. On balance, Farah and others have found very little to no improvement when their research subjects confront these tests on Adderall. Ultimately, she says, it is possible that “lower-performing people actually do improve on the drug, and higher-performing people show no improvement or actually get worse.” My pill-free period didn’t last very long. I turned in my incomplete school work and duly received my grades, but by graduation that spring, I was again locked into the familiar pattern, the blissful intensity and isolation followed by days of slow-motion comedown, when I would laze around for hours, eating spoonfuls of ice cream from the carton, desperate for the sugar rush, barely able to muster the energy necessary to take a shower. It took me exactly one year from the time of college graduation to come to the decision that would, to a great extent, shape the next phase of my life. It hit me like a revelation: It might be possible to declare my independence from the various A.D.H.D. kids who sold me their prescription pills at exorbitant markups and get a prescription all my own. The idea occurred to me as I walked among the palm trees on the campus of U.C.L.A. By then, I was living in Los Angeles, working as a private tutor for high-school kids, many of whom were themselves on Adderall, and taking summer-school classes in psychology and neuroscience in order to be able to apply for graduate school. I had decided I wanted to be a psychologist — infinitely more manageable than my secret ambition of being a writer, I thought. Infinitely more realistic. Like many 20-somethings, my decisions were informed by panic and haste, but also, of course, by whatever short-lived supply of the pills I happened to be in possession of. I was now surrounded — or had surrounded myself — by others caught up in the Adderall web. Together with two of my closest friends in Los Angeles that year, we traversed the city in a state of perpetual, hyped-up intensity, exchanging confidences that later we would not recall. Adderall was the currency of our friendship; when one of us ran short of pills, another would cover the deficit. Driving through Los Angeles in a sun-drenched trance, weaving in and out of traffic, I found it all too easy to lose track of exactly how many pills I had swallowed that day. As soon as it occurred to me that I might be able to get my own prescription, I went to the nearest campus computer and searched for “cognitive behavioral psychiatrist, Westwood, Los Angeles, California.” I knew enough about psychology by then to avoid the psychoanalysts, who would want to go deep and talk to me for weeks or maybe months about why I felt I needed chemical enhancement. No, I couldn’t turn to them — I needed a therapist with an M.D., a focus on concrete “results” and an office within a 10-minute drive of U.C.L.A. The very next day, I was sitting in exactly the kind of place I had envisioned, an impersonal room with gray walls and black leather furniture, describing to the attractive young psychiatrist in the chair opposite me how I had always had to develop elaborate compensatory strategies for getting through my school work, how staying with any one thing was a challenge for me, how I was best at jobs that required elaborate multitasking, like waitressing. Untrue, all of it. I was a focused student and a terrible waitress. And yet these were the answers that I discovered from the briefest online research were characteristic of the A.D.H.D. diagnostic criteria. These were the answers they were looking for in order to pick up their pens and write down “Adderall, 20 mg, once a day” on their prescription pads. So these were the answers I gave. Fifty minutes later, I was standing on San Vicente Boulevard in the bright California sun, prescription slip in hand. That single doctor’s assessment, granted in less than an hour, would follow me everywhere I went: through the rest of my time in Los Angeles; then off to London, with the help of FedEx; then to New Haven, where I would pick it up once a month at the Yale Health Center; then back to New York, where the doctor I found on my insurance plan would have no problem continuing to prescribe this medication, based only on my saying that it had been previously prescribed to me, that I’d been taking it for years. Any basic neuroscience textbook will explain how Adderall works in the brain — and why it’s so hard to break the habit. For years, the predominant explanation of addiction, promulgated by researchers like Nora Volkow, director of the National Institute on Drug Abuse, has revolved around the neurotransmitter dopamine. Amphetamines unleash dopamine along with norepinephrine, which rush through the brain’s synapses and increase levels of arousal, attention, vigilance and motivation. Dopamine, in fact, tends to feature in every experience that feels especially great, be it having sex or eating chocolate cake. It’s for this reason that dopamine is so heavily implicated in current models of addiction. As a person begins to overuse a substance, the brain — which craves homeostasis and fights for it — tries to compensate for all the extra dopamine by stripping out its own dopamine receptors. With the reduction of dopamine receptors, the person needs more and more of her favored substance to produce the euphoria it once offered her. The vanishing dopamine receptors also help explain the agony of withdrawal: Without that favored substance, a person is suddenly left with a brain whose capacity to experience reward is well below its natural levels. It is an open question whether every brain returns to its original settings once off the drug. Nearly three years after getting the prescription, in 2008, I found myself sobbing in a psychiatrist’s office in New Haven, where I was finishing graduate school, explaining to him that my life was no longer my own. I had long been telling myself that by taking Adderall, I was exerting total control over my fallible self, but in truth, it was the opposite: The Adderall made my life unpredictable, blowing black storm systems over my horizon with no warning at all. Still, I couldn’t give it up. The psychiatrist was a kind Serbian man with an unflappable expression. He observed my distress calmly and prescribed Wellbutrin, an antidepressant with a slightly speedy quality that could cushion the blow of withdrawal and make it less painful to get off the Adderall. His theory was sound. But soon enough, I was simply taking both medications. Through my Adderall years, I lived a paradox, believing that the drug was indispensable to my very survival while also knowing that it was nothing short of toxic, poisonous to art, love and life. By 2009, I had a contract to write a book about psychoanalysis and neuroscience; shortly after, I took a day job as a reporter for a news website. What was required of me there was the constant filing of short, catchy pieces: to be quick and glib and move on to the next one. It was the kind of rhythm perfect for an Adderall-head like me — and the kind of writing at odds with the effort to think slowly and carefully, at book length. The goal of slow and careful thinking came to feel more and more anachronistic with each passing week. It didn’t escape me that just as Adderall was surging onto the market in the 1990s, so, too, was the internet, that the two have ascended within American life in perfect lock-step. I was terrified I had done something irreversible to my brain, terrified that I was going to discover that I couldn’t write at all without my special pills. Occasionally, I would try to get off the drug. Each attempt began the same way. Step 1: the rounding up of all the pills in my possession, including those secret stashes hidden away in drawers and closets. Debating for hours whether to keep just one, “for emergencies.” Then the leap of faith and the flushing of the pills down the toilet. Step 2: a day or two of feeling all right, as if I could manage this after all. Step 3: a bleak slab of time when the effort needed to get through even the simple tasks of a single day felt stupendous, where the future stretched out before me like a grim series of obligations I was far too tired to carry out. All work on my book would stop. Panic would set in. Then, suddenly, an internal Adderall voice would take over, and I would jump up from my desk and scurry out to refill my prescription — almost always a simple thing to achieve — or borrow pills from a friend, if need be. And the cycle would begin again. Those moments were all shrouded in secrecy and shame. Very few people in my life knew the extent to which the drug had come to define me. Over the years, I’ve been told by various experts on the subject that it should not have been so hard to get off Adderall. The drug is supposed to be relatively quick and painless to relinquish. I’ve often wondered whether my inability to give it up was my deepest failing. I’ve found some comfort in seeing my own experience mirrored back to me in the dozens and dozens of disembodied voices on the internet, filling the message boards of the websites devoted to giving up this drug. One post, in particular, has stayed with me, a mother writing on QuittingAdderall.com: I started taking Adderall in OCT 2010. And my story isn’t much different than most. ... The honeymoon period, then all downhill. I feel like I cannot remember who I was, or how it felt, to go one minute of the day not on Adderall. I look back at pictures of myself from before this began and I wonder how I was ever “happy” without it because now I am a nervous wreck if I even come close to not having my pills for the day. There have been nights I have cried laying my daughter down to sleep because I was so ashamed that the time she spent with her mommy that day wasn’t real. “Nobody starts off by saying, I’m going to go develop a drug problem,” said Jeanette Friedman, a social worker with a specialty in addiction, when I met her in August at her Upper East Side office. “No one means to get addicted. But there’s such a casual use of something like Adderall nowadays — because it’s seen as benign, or a help to becoming more productive. And in our culture, to be productive is kind of everything. There’s a tremendous pressure not just to do well but to excel.” When she is face to face with an addicted patient, Friedman explains, what is at stake is that patient’s very ability “to become a full person without the shadow of always needing something.” Adderall complicates the usual dynamic of drug addiction by being squarely associated with productivity, achievement and success. “It’s very hard to think about going off it, because you don’t know if you’re going to be able to produce,” she says. “Plenty of people have gone off of it and have been able to tell the story, that yes, they definitely can produce. But the fear of not being able to is what keeps people still using.” I remember that fear, in school and, later, at work, and it’s palpable in those message-board pleas: The way I feel now is way worse than my A.D.D. ever was before I went on this stuff. I no longer feel, at this present time, able to get a Ph.D. I don’t feel able to do coursework, I don’t feel interested and passionate about the things I loved. I need to know from you, dear readers, that this will be temporary. Harris Stratyner, a psychologist and addiction specialist at the Caron Treatment Center in Manhattan, told me that each year he’s in practice, he sees more people desperate to get off Adderall. Stratyner estimates that he has treated more than 50 patients trying to stop using the drug; currently, they range in age from 24 to 40. His Adderall patients are overwhelmingly creative people who wanted to work in the arts — yet, he says, many have chosen other paths, safer paths, resigning themselves before they’ve even really tried to achieve what they hoped for. “They often give in to practicality,” he says. “Then they feel they missed out. And when they take Adderall, it makes them feel good, so they don’t focus on the fact that they feel like they sold out.” Many people are using Adderall to mask a sense of disappointment in themselves, Stratyner says, because it narrows their focus down to simply getting through each day, instead of the larger context of what they’re trying to build with their lives. “It becomes extremely psychologically and physiologically addictive,” he says. “It’s really a tough drug to get off of.” The side effects of Adderall withdrawal that his patients report include nausea, chills, diarrhea, body aches and pains, even seizures. Occasionally, it is necessary for him to hospitalize his patients as they come down off Adderall. In the end, I did not get off Adderall alone. I had a brilliant psychiatrist. I believe she saved my life. On the wall of her office, she had a single image: a framed print of an Henri Matisse painting. Through our time together, Matisse came to stand for the creative process. You start one place, go through hell and wind up somewhere else, somewhere that surprises you. Adderall, we both agreed, was a perversion of that journey. Gradually, her words entered my inner dialogue and sustained me. I was 30 by the time I got off Adderall for good. This statement horrifies me even now, more than three years later, recognizing the amount of precious time I gave away to that drug. During the first weeks of finally giving up Adderall, the fatigue was as real as it had been before, the effort required to run even a tiny errand momentous, the gym unthinkable. The cravings were a force of their own: If someone so much as said “Adderall” in my presence, I would instantly begin to scheme about how to get just one more pill. Or maybe two. I was anxious, terrified I had done something irreversible to my brain, terrified that I was going to discover that I couldn’t write at all without my special pills. I didn’t yet know that it would only be in the amphetamine-free years to follow that my book would finally come together. Even in those first faltering weeks, there were consolations. Simple pleasures were available to me again. I laughed more in conversation with my friends, and I noticed that they did, too. I had spent years of my life in a state of false intensity, always wondering if I should be somewhere else, working harder, achieving more. In the deep lethargy of withdrawal, I could shed that chemical urgency that kept me at a subtle distance from everyone around me — and from myself. On one of those earliest days of being off the drug, I was moving slowly, more than a little daunted, trying to walk the few miles to an appointment I had in Midtown Manhattan. It was a glorious summer evening, the sun just going down. As I approached Bryant Park, I heard live music and wandered in to see. A rock band was performing onstage. I hovered at the back of the crowd. The singer, muscular and bearded, gripped the microphone in front of him with two hands, pouring his heart into every word that left his mouth. His voice soared into that summer night. Suddenly, tears were streaming down my face. I was embarrassed, but I couldn’t stop. It was as if I hadn’t heard music in years. Casey Schwartz is the author of “In the Mind Fields: Exploring the New Science of Neuropsychoanalysis.” She last wrote for the magazine on whether brain-scanning can help save Freudian psychoanalysis. Sign up for our newsletter to get the best of The New York Times Magazine delivered to your inbox every week. A version of this article appears in print on October 16, 2016, on Page MM54 of the Sunday Magazine with the headline: Generation Adderall. Today's Paper|Subscribe Continue reading the main story TRENDING Trump Says Focus on Russian Hacking Is a ‘Political Witch Hunt’ Inside a Killer Drug Epidemic: A Look at America’s Opioid Crisis Transition Briefing: Trump’s Long-Awaited Briefing on Russian Election Interference Nears In Break With Precedent, Obama Envoys Are Denied Extensions Past Inauguration Day 52 Places to Go in 2017 Op-Ed Contributor: Why Rural America Voted for Trump Countering Trump, Bipartisan Voices Strongly Affirm Findings on Russian Hacking Feature: One Man’s Quest to Change the Way We Die Op-Ed Columnist: The Age of Fake Policy News Analysis: Michelle Obama Can Now Speak Her Mind. Will She? View More Trending Stories » More in Magazine

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