In Crisis, She Went to an Illinois Facility. Two Years Later, She Still Isn’t Able to Leave.

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Series: Culture of Cruelty:Inside Illinois’ Mental Health System

State-run facilities in Illinois are supposed to care for people with mental and developmental disabilities. But patients have been subjected to abuse, neglect and staff misconduct for decades, despite calls for change.

Kaleigh Rogers was in crisis when she checked into a state-run institution on Illinois’ northern border two years ago. Rogers, who has cerebral palsy, had a mental health breakdown during the pandemic and was acting aggressively toward herself and others.

Before COVID-19, she had been living in a small group home; she had been taking college classes online and enjoyed going out with friends, volunteering and going to church. But when her aggression escalated, she needed more medical help than her community setting could provide.

With few viable options for intervention, she moved into Kiley Developmental Center in Waukegan, a much larger facility. There, she says she has fewer freedoms and almost nothing to do, and was placed in a unit with six other residents, all of whom are unable to speak. Although the stay was meant to be short term, she’s been there for two years.

The predicament facing Rogers and others like her is proof, advocates say, that the state is failing to live up to the promise it made in a 13-year-old federal consent decree to serve people in the community.

Rogers, 26, said she has lost so much at Kiley: her privacy, her autonomy and her purpose. During dark times, she cries on the phone to her mom, who has reduced the frequency of her visits because it is so upsetting for Rogers when her mom has to leave.

The 220-bed developmental center about an hour north of Chicago is one of seven in the state that have been plagued by allegations of abuse and other staff misconduct. The facilities have been the subject of a monthslong investigation by Capitol News Illinois and ProPublica about the state’s failures to correct poor conditions for people with intellectual and developmental disabilities. The news organizations uncovered instances of staff who had beaten, choked, thrown, dragged and humiliated residents inside the state-run facilities.

Advocates hoped the state would become less reliant on large institutions like these when they filed a lawsuit in 2005, alleging that Illinois’ failure to adequately fund community living options ended up segregating people with intellectual and developmental disabilities from society by forcing them to live in institutions. The suit claimed Illinois was in direct violation of a 1999 U.S. Supreme Court decision in another case, which found that states had to serve people in the most integrated setting of their choosing.

Negotiations resulted in a consent decree, a court-supervised improvement plan. The state agreed to find and fund community placements and services for individuals covered by the consent decree, thousands of adults with intellectual and developmental disabilities across Illinois who have put their names on waiting lists to receive them.

Now, the state has asked a judge to consider ending the consent decree, citing significant increases in the number of people receiving community-based services. In a court filing in December, Illinois argued that while its system is “not and never will be perfect,” it is “much more than legally adequate.”

But advocates say the consent decree should not be considered fulfilled as long as people with disabilities continue to live without the services and choices that the state promised.

Across the country, states have significantly downsized or closed their large-scale institutions for people with developmental and intellectual disabilities in favor of smaller, more integrated and more homelike settings.

But in Illinois, a national outlier, such efforts have foundered. Efforts to close state-operated developmental centers have been met with strong opposition from labor unions, the communities where the centers are located, local politicians and some parents.

U.S. District Judge Sharon Johnson Coleman in Chicago is scheduled in late summer to decide whether the state has made enough progress in building up community supports to end the court’s oversight.

For some individuals like Rogers, who are in crisis or have higher medical or behavioral challenges, the state itself acknowledges that it has struggled to serve them in community settings. Rogers said she’d like to send this message on behalf of those in state-operated developmental centers: “Please, please get us out once and for all.”

“Living Inside a Box”

Without a robust system of community-based resources and living arrangements to intervene during a crisis, state-operated developmental centers become a last resort for people with disabilities. But under the consent decree agreement, the state, Equip for Equality argues, is expected to offer sufficient alternative crisis supports to keep people who want them out of these institutions.

In a written response to questions, Rachel Otwell, a spokesperson for the Illinois Department of Human Services, said the state has sought to expand the menu of services it offers people experiencing a crisis, in an effort to keep them from going into institutions. But Andrea Rizor, a lawyer with Equip for Equality, said, “They just don’t have enough to meet the demand.”

For example, the state offers stabilization homes where people can live for 90 days while they receive more intensive support from staff serving the homes, including medication reviews and behavioral interventions. But there are only 32 placements available — only four of them for women — and the beds are always full, Rizor said.

Too many people, she said, enter a state-run institution for short-term treatment and end up stuck there for years for various reasons, including shortcomings with the state’s discharge planning and concerns from providers who may assume those residents to be disruptive or difficult to serve without adequate resources.

That’s what happened to Rogers. Interruptions to her routine and isolation during the pandemic sent her anxiety and aggressive behaviors into overdrive. The staff at her community group home in Machesney Park, unsure of what to do when she acted out, had called the police on several occasions.

Doctors also tried to intervene, but the cocktail of medications she was prescribed turned her into a “zombie,” Rogers said. Stacey Rogers, her mom and legal guardian, said she didn’t know where else to turn for help. Kiley, she said, “was pretty much the last resort for us,” but she never intended for her daughter to be there for this long. She’s helped her daughter apply to dozens of group homes over the past year. A few put her on waitlists; most have turned her down.

“Right now, all she’s doing is living inside a box,” Stacey Rogers said.

Although Rogers gave the news organizations permission to ask about her situation, IDHS declined to comment, citing privacy restrictions. In general, the IDHS spokesperson said that timelines for leaving institutions are “specific to each individual” and their unique preferences, such as where they want to live and speciality services they may require in a group home.

Equip for Equality points to people like Rogers to argue that the consent decree has not been sufficiently fulfilled. She’s one of several hundred in that predicament, the organization said.

“If the state doesn’t have capacity to serve folks in the community, then the time is not right to terminate this consent decree, which requires community capacity,” Rizor said.

Equip for Equality has said that ongoing safety issues in these facilities make it even more important that people covered by the consent decree not be placed in state-run institutions. In an October court brief, citing the news organizations’ reporting, Equip for Equality said that individuals with disabilities who were transferred from community to institutional care in crisis have “died, been raped, and been physically and mentally abused.”

Over the summer, an independent court monitor assigned to provide expert opinions in the consent decree, in a memo to the court, asked a judge to bar the state from admitting those individuals into its institutions.

In its December court filing, the state acknowledged that there are some safety concerns inside its state-run centers, “which the state is diligently working on,” as well as conditions inside privately operated facilities and group homes “that need to be addressed.” But it also argued that conditions inside its facilities are outside the scope of the consent decree. The lawsuit and consent decree specifically aimed to help people who wanted to move out of large private institutions, but plaintiffs’ attorneys argue that the consent decree prohibits the state from using state-run institutions as backup crisis centers.

In arguing to end the consent decree, the state pointed to significant increases in the number of people served since it went into effect. There were about 13,500 people receiving home- and community-based services in 2011 compared with more than 23,000 in 2023, it told the court.

The state also said it has significantly increased funding that is earmarked to pay front-line direct support professionals who assist individuals with daily living needs in the community, such as eating and grooming.

In a statement to reporters, the human services department called these and other improvements to the system “extraordinary.”

Lawyers for the state argued that those improvements are enough to end court oversight.

“The systemic barriers that were in place in 2011 no longer exist,” the state’s court filing said.

Among those who were able to find homes in the community is Stanley Ligas, the lead plaintiff in the lawsuit that led to the consent decree. When it was filed in 2005, he was living in a roughly 100-bed private facility but wanted to move into a community home closer to his sister. The state refused to fund his move.

Today, the 56-year-old lives in Oswego with three roommates in a house they rent. All of them receive services to help their daily living needs through a nonprofit, and Ligas has held jobs in the community: He previously worked in a bowling alley and is now paid to make public appearances to advocate for others with disabilities. He lives near his sister, says he goes on family beach vacations and enjoys watching professional wrestling with friends. During an interview with reporters, Ligas hugged his caregiver and said he’s “very happy” and hopes others can receive the same opportunities he’s been given.

While much of that progress has come only in recent years, under Gov. JB Pritzker’s administration, it has proven to be vulnerable to political and economic changes. After a prolonged budget stalemate, the court in 2017 found Illinois out of compliance with the Ligas consent decree.

At the time, late and insufficient payments from the state had resulted in a staffing crisis inside community group homes, leading to escalating claims of abuse and neglect and failures to provide routine services that residents relied on, such as help getting to work, social engagements and medical appointments in the community. Advocates worry about what could happen under a different administration, or this one, if Illinois’ finances continue to decline as projected.

“I acknowledge the commitments that this administration has made. However, because we had so far to come, we still have far to go,” said Kathy Carmody, chief executive of The Institute on Public Policy for People with Disabilities, which represents providers.

While the wait for services is significantly shorter than it was when the consent decree went into effect in 2011, there are still more than 5,000 adults who have told the state they want community services but have yet to receive them, most of them in a family home. Most people spend about five years waiting to get the services they request. And Illinois continues to rank near the bottom in terms of the investment it makes in community-based services, according to a University of Kansas analysis of states’ spending on services for people with intellectual and developmental disabilities.

Advocates who believe the consent decree has not been fulfilled contend that Illinois’ continued reliance on congregate settings has tied up funds that could go into building up more community living options. Each year, Illinois spends about $347,000 per person to care for those in state-run institutions compared with roughly $91,000 per person spent to support those living in the community.

For Rogers, the days inside Kiley are long, tedious and sometimes chaotic. It can be stressful, but Rogers told reporters that she uses soothing self-talk to calm herself when she feels sad or anxious.

“I tell myself: ‘You are doing good. You are doing great. You have people outside of here that care about you and cherish you.’”

This article is republished from ProPublica under a Creative Commons license. Read the original article.

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  • Dealing with Thirst!

    10almonds is reader-supported. We may, at no cost to you, receive a portion of sales if you purchase a product through a link in this article.

    Busting The Myth of “Eight Glasses Of Water A Day”

    Everyone knows we must drink 8 glasses of water a day, or else we’re going to get a failing grade at being a healthy human—like not flossing, or not using adequate sunscreen.

    But… Do we? And does tea count? How about (we dare but whisper it) coffee? And soda drinks are mostly water, right? But aren’t some drinks dehydrating? Are special electrolyte drinks really better? There are so many things to consider, so many differing advices, and it’s easy to give up, or just choose what to believe in as a leap of faith.

    A quick brain-teaser for you first, though:

    If coffee and soda don’t count because they’re dehydrating, then what if you were to take:

    – A concentrated tiny cup of espresso, and then a glass of water, would the glass of water count?

    Or (we don’t relish the thought) what if you took a spoonful of soda syrup, and then a glass of water, would the glass of water count?

    If your answer was “yes, it’s a glass of water”, then why would it not count if it were taken all at once (e.g. as an Americano coffee, or a regular soda)?

    If your answer was “yes, but that water might only offset the dehydration caused by the coffee/syrup, so I might only be breaking even”, then you were thinking about this the right way:

    How much water you need depends on many factors that can be affected by what else you are consuming and what else you are doing. Science loves averages, so eight glasses a day may be great if you are of average health, and average body size, in a temperate climate, doing moderate exercise, and so on and so on.

    If you’re not the most average person of all time? You may need to take into account a lot of factors, ranging from what you ate for dinner to how much you perspired during your morning exercises. As you (probably) don’t live in laboratory conditions, this can become an impossible task—and if you missed (or guessed incorrectly) even one factor, the whole calculation will be thrown off. But is there any other way to know?

    What of the infamous pee test? Drink enough to make your urine as clear as possible, and if it’s dark, you’re dehydrated, common wisdom says.

    In reality, however, that tells you not what’s in your body, but rather, what got ejected from your body. If your urine is dark, it might mean you had too little water, but it also could just mean you had the right amount of water but too much sodium, for instance. A study of this was done on athletes, and found no correlation between urine color and actual bodily hydration when measured directly via a blood test.

    So, if we can’t just have an app tell us “drink this many glasses of water”, and we can’t trust urine color, what can we do?

    What we can do is trust that our body comes with (for free!) a wonderful homeostatic system and it will try to correct any imbalances. If you are thirsty, you’re dehydrated. Drink something with plenty of water in, if not plain water.

    But what about special electrolyte drinks? If you need salts, you will crave them. Craving a salty snack? Go for it! Or if you prefer not to snack, do a salt lick test (just put a little salt on your finger, and taste it; if it tastes good, wait a minute or two, and then have a little more, and repeat until it doesn’t).

    Bonus Tip:

    1. Make sure you always have a source of hydration (that you enjoy!) to hand. Maybe it’s chilled water, maybe it’s a pot of tea, maybe it’s a sports drink, it doesn’t matter too much. Even coffee is actually fine, by the way (but don’t overdo it).
    2. Make a personal rule: “I will always make time for hydration”. That means, if you’re thirsty, have something with water in it now. Not when you’ve finished what you’re doing (unless you really can’t stop, because you are a racecar driver mid-race, or a surgeon mid-operation, or something), but now. Do not postpone it until after you’ve done some other thing first; you will forget and it will keep getting postponed. Always make time for water.

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  • Rethinking Exercise: The Workout Paradox

    10almonds is reader-supported. We may, at no cost to you, receive a portion of sales if you purchase a product through a link in this article.

    The notion of running a caloric deficit (i.e., expending more calories than we consume) to reduce bodyfat is appealing in its simplicity, but… we’d say “it doesn’t actually work outside of a lab”, but honestly, it doesn’t actually work outside of a calculator.

    Why?

    For a start, exercise calorie costs are quite small numbers compared to metabolic base rate. Our brain alone uses a huge portion of our daily calories, and the rest of our body literally never stops doing stuff. Even if we’re lounging in bed and ostensibly not moving, on a cellular level we stay incredibly busy, and all that costs (and the currency is: calories).

    Since that cost is reflected in the body’s budget per kg of bodyweight, a larger body (regardless of its composition) will require more calories than a smaller one. We say “regardless of its composition” because this is true regardless—but for what it’s worth, muscle is more “costly” to maintain than fat, which is one of several reasons why the average man requires more daily calories than the average woman, since on average men will tend to have more muscle.

    And if you do exercise because you want to run out the budget so the body has to “spend” from fat stores?

    Good luck, because while it may work in the very short term, the body will quickly adapt, like an accountant seeing your reckless spending and cutting back somewhere else. That’s why in all kinds of exercise except high-intensity interval training, a period of exercise will be followed by a metabolic slump, the body’s “austerity measures”, to balance the books.

    You may be wondering: why is it different for HIIT? It’s because it changes things up frequently enough that the body doesn’t get a chance to adapt. To labor the financial metaphor, it involves lying to your accountant, so that the compensation is not made. Congratulations: you’re committing calorie fraud (but it’s good for the body, so hey).

    That doesn’t mean other kinds of exercise are useless (or worse, necessarily counterproductive), though! Just, that we must acknowledge that other forms of exercise are great for various aspects of physical health (strengthening the body, mobilizing blood and lymph, preventing disease, enjoying mental health benefits, etc) that don’t really affect fat levels much (which are decided more in the kitchen than the gym—and even in the category of diet, it’s more about what and how and when you eat, rather than how much).

    For more information on metabolic balance in the context of exercise, enjoy:

    Click Here If The Embedded Video Doesn’t Load Automatically!

    Want to learn more?

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    Take care!

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  • Hearing loss is twice as common in Australia’s lowest income groups, our research shows

    10almonds is reader-supported. We may, at no cost to you, receive a portion of sales if you purchase a product through a link in this article.

    Around one in six Australians has some form of hearing loss, ranging from mild to complete hearing loss. That figure is expected to grow to one in four by 2050, due in a large part to the country’s ageing population.

    Hearing loss affects communication and social engagement and limits educational and employment opportunities. Effective treatment for hearing loss is available in the form of communication training (for example, lipreading and auditory training), hearing aids and other devices.

    But the uptake of treatment is low. In Australia, publicly subsidised hearing care is available predominantly only to children, young people and retirement-age people on a pension. Adults of working age are mostly not eligible for hearing health care under the government’s Hearing Services Program.

    Our recent study published in the journal Ear and Hearing showed, for the first time, that working-age Australians from lower socioeconomic backgrounds are at much greater risk of hearing loss than those from higher socioeconomic backgrounds.

    We believe the lack of socially subsidised hearing care for adults of working age results in poor detection and care for hearing loss among people from disadvantaged backgrounds. This in turn exacerbates social inequalities.

    Population data shows hearing inequality

    We analysed a large data set called the Household, Income and Labour Dynamics in Australia (HILDA) survey that collects information on various aspects of people’s lives, including health and hearing loss.

    Using a HILDA sub-sample of 10,719 working-age Australians, we evaluated whether self-reported hearing loss was more common among people from lower socioeconomic backgrounds than for those from higher socioeconomic backgrounds between 2008 and 2018.

    Relying on self-reported hearing data instead of information from hearing tests is one limitation of our paper. However, self-reported hearing tends to underestimate actual rates of hearing impairment, so the hearing loss rates we reported are likely an underestimate.

    We also wanted to find out whether people from lower socioeconomic backgrounds were more likely to develop hearing loss in the long run.

    A boy wearing a hearing aid is playing.
    Hearing care is publicly subsidised for children.
    mady70/Shutterstock

    We found people in the lowest income groups were more than twice as likely to have hearing loss than those in the highest income groups. Further, hearing loss was 1.5 times as common among people living in the most deprived neighbourhoods than in the most affluent areas.

    For people reporting no hearing loss at the beginning of the study, after 11 years of follow up, those from a more deprived socioeconomic background were much more likely to develop hearing loss. For example, a lack of post secondary education was associated with a more than 1.5 times increased risk of developing hearing loss compared to those who achieved a bachelor’s degree or above.

    Overall, men were more likely to have hearing loss than women. As seen in the figure below, this gap is largest for people of low socioeconomic status.

    Why are disadvantaged groups more likely to experience hearing loss?

    There are several possible reasons hearing loss is more common among people from low socioeconomic backgrounds. Noise exposure is one of the biggest risks for hearing loss and people from low socioeconomic backgrounds may be more likely to be exposed to damaging levels of noise in jobs in mining, construction, manufacturing, and agriculture.

    Lifestyle factors which may be more prevalent in lower socioeconomic communities such as smoking, unhealthy diet, and a lack of regular exercise are also related to the risk of hearing loss.

    Finally, people with lower incomes may face challenges in accessing timely hearing care, alongside competing health needs, which could lead to missed identification of treatable ear disease.

    Why does this disparity in hearing loss matter?

    We like to think of Australia as an egalitarian society – the land of the fair go. But nearly half of people in Australia with hearing loss are of working age and mostly ineligible for publicly funded hearing services.

    Hearing aids with a private hearing care provider cost from around A$1,000 up to more than $4,000 for higher-end devices. Most people need two hearing aids.

    A builder using a grinder machine at a construction site.
    Hearing loss might be more common in low income groups because they’re exposed to more noise at work.
    Dmitry Kalinovsky/Shutterstock

    Lack of access to affordable hearing care for working-age adults on low incomes comes with an economic as well as a social cost.

    Previous economic analysis estimated hearing loss was responsible for financial costs of around $20 billion in 2019–20 in Australia. The largest component of these costs was productivity losses (unemployment, under-employment and Jobseeker social security payment costs) among working-age adults.

    Providing affordable hearing care for all Australians

    Lack of affordable hearing care for working-age adults from lower socioeconomic backgrounds may significantly exacerbate the impact of hearing loss among deprived communities and worsen social inequalities.

    Recently, the federal government has been considering extending publicly subsidised hearing services to lower income working age Australians. We believe reforming the current government Hearing Services Program and expanding eligibility to this group could not only promote a more inclusive, fairer and healthier society but may also yield overall cost savings by reducing lost productivity.

    All Australians should have access to affordable hearing care to have sufficient functional hearing to achieve their potential in life. That’s the land of the fair go.The Conversation

    Mohammad Nure Alam, PhD Candidate in Economics, Macquarie University; Kompal Sinha, Associate Professor, Department of Economics, Macquarie University, and Piers Dawes, Professor, School of Health and Rehabilitation Sciences, The University of Queensland

    This article is republished from The Conversation under a Creative Commons license. Read the original article.

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    10almonds is reader-supported. We may, at no cost to you, receive a portion of sales if you purchase a product through a link in this article.

    How Good Is Your Sleep, Really?

    Dr. Marie Pierre St. Onge is an expert in sleep behavior and how different dimensions of sleep matter for overall health.

    This is Dr. Marie-Pierre St-Onge, Director of Columbia University’s Center of Excellence for Sleep and Circadian Research.

    The focus of Dr. St-Onge’s research is the study of the impact of lifestyle, especially sleep and diet, on cardio-metabolic risk factors.

    She conducts clinical research combining her expertise on sleep, nutrition, and energy regulation.

    What kind of things do her studies look at?

    Her work focuses on questions about…

    • The role of circadian rhythms (including sleep duration and timing)
    • Meal timing and eating patterns

    …and their impact on cardio-metabolic risk.

    What does she want us to know?

    First things first, when not to worry:

    ❝Getting a bad night’s sleep once in a while isn’t anything to worry about. That’s what we would describe as transient insomnia. Chronic insomnia occurs when you spend three months or more without regular sleep, and that is when I would start to be concerned.❞

    But… as prevention is (as ever) better than cure, she also advises that we do pay attention to our sleep! And, as for how to do that…

    The Six Dimensions of Sleep

    One useful definition of overall sleep health is the RU-Sated framework, which assesses six key dimensions of sleep that have been consistently associated with better health outcomes. These are:

    • regularity
    • satisfaction with sleep
    • alertness during waking hours
    • timing of sleep
    • efficiency of sleep
    • duration of sleep

    You’ll notice that some of these things you can only really know if you use a sleep-monitoring app. She does recommend the use of those, and so do we!

    We reviewed and compared some of the most popular sleep-monitoring apps! You can check them out here: Time For Some Pillow Talk

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    AROUND THE WEB

    What’s happening in the health world…

    More to come tomorrow!

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  • Pinch of Nom – by Kate Allinson & Kay Allinson

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    “Home-style recipes”, because guess where most readers live!

    And: slimming, because trimming the waistline a little is a goal for many after holiday indulgences.

    The key idea here is healthy recipes that “don’t taste like diet food”—often by just switching out a couple of key ingredients, to give a significantly improved nutritional profile while remaining just as tasty, especially when flavors are enhanced with clever spicing and seasoning.

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    Click here to check out Pinch of Nom, and liven up your healthy cooking!

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  • The 6 Pillars Of Nutritional Psychiatry

    10almonds is reader-supported. We may, at no cost to you, receive a portion of sales if you purchase a product through a link in this article.

    Dr. Naidoo’s To-Dos

    This is Dr. Uma Naidoo. She’s a Harvard-trained psychiatrist, professional chef graduating with her culinary school’s most coveted award, and a trained nutritionist. Between those three qualifications, she knows her stuff when it comes to the niche that is nutritional psychiatry.

    She’s also the Director of Nutritional and Lifestyle Psychiatry at Massachusetts General Hospital (MGH) & Director of Nutritional Psychiatry at MGH Academy while serving on the faculty at Harvard Medical School.

    What is nutritional psychiatry?

    Nutritional psychiatry is the study of how food influences our mood (in the short term) and our more generalized mental health (in the longer term).

    We recently reviewed a book of hers on this topic:

    This Is Your Brain On Food – by Dr. Uma Naidoo

    The “Six Pillars” of nutritional psychiatry

    Per Dr. Naidoo, these are…

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    See also: The Brain-Gut Highway: A Two-Way Street

    Eat The Rainbow

    This one’s simple enough and speaks for itself. Very many brain-nutrients happen to be pigments, and “eating the rainbow” (plants, not Skittles!) is a way to ensure getting a lot of different kinds of brain-healthy flavonoids and other phytonutrients.

    The Greener, The Better

    As Dr. Naidoo writes:

    ❝Greens contain folate, an important vitamin that maintains the function of our neurotransmitters. Its consumption has been associated with a decrease in depressive symptoms and improved cognition.❞

    Tap into Your Body Intelligence

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    Basically, the same advice here as from: The Kitchen Doctor

    (do check that out, as there’s more there than we have room to repeat here today!)

    Consistency & Balance Are Key

    Honestly, this one’s less a separate item and is more a reiteration of the 80/20 rule discussed in the first pillar, and an emphasis on creating sustainable change rather than loading up on brain-healthy superfoods for half a weekend and then going back to one’s previous dietary habits.

    Avoid Anxiety-Triggering Foods

    This is about avoiding sugar/HFCS, ultra-processed foods, and industrial seed oils such as canola and similar.

    As for what to go for instead, she has a broad-palette menu of ingredients she recommends using as a base for one’s meals (remember she’s a celebrated chef as well as a psychiatrist and nutritionist), which you can check out here:

    Dr. Naidoo’s “Food for Mood” project

    Enjoy!

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