Increase in online ADHD diagnoses for kids poses ethical questions
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In 2020, in the midst of a pandemic, clinical protocols were altered for Ontario health clinics, allowing them to perform more types of care virtually. This included ADHD assessments and ADHD prescriptions for children – services that previously had been restricted to in-person appointments. But while other restrictions on virtual care are back, clinics are still allowed to virtually assess children for ADHD.
This shift has allowed for more and quicker diagnoses – though not covered by provincial insurance (OHIP) – via a host of newly emerging private, for-profit clinics. However, it also has raised significant ethical questions.
It solves an equity issue in terms of rural access to timely assessments, but does it also create new equity issues as a privatized service?
Is it even feasible to diagnose a child for a condition like ADHD without meeting that child in person?
And as rates of ADHD diagnosis continue to rise, should health regulators re-examine the virtual care approach?
Ontario: More prescriptions, less regulation
There are numerous for-profit clinics offering virtual diagnoses and prescriptions for childhood ADHD in Ontario. These include KixCare, which does not offer the option of an in-person assessment. Another clinic, Springboard, makes virtual appointments available within days, charging around $2,600 for assessments, which take three to four hours. The clinic offers coaching and therapy at an additional cost, also not covered by OHIP. Families can choose to continue to visit the clinic virtually during a trial stage with medications, prescribed by a doctor in the clinic who then sends prescribing information back to the child’s primary care provider.
For-profit clinics like these are departing from Canada’s traditional single-payer health care model. By charging patients out-of-pocket fees for services, the clinics are able to generate more revenue because they are working outside of the billing standards for OHIP, standards that set limits on the maximum amount doctors can earn for providing specific services. Instead many services are provided by non-physician providers, who are not limited by OHIP in the same way.
Need for safeguards
ADHD prescriptions rose during the pandemic in Ontario, with women, people of higher income and those aged 20 to 24 receiving the most new diagnoses, according to research published in January 2024 by a team including researchers from the Centre for Addictions and Mental Health and Holland Bloorview Children’s Hospital. There may be numerous reasons for this increase but could the move to virtual care have been a factor?
Ontario psychiatrist Javeed Sukhera, who treats both children and adults in Canada and the U.S., says virtual assessments can work for youth with ADHD, who may receive treatment quicker if they live in remote areas. However, he is concerned that as health care becomes more privatized, it will lead to exploitation and over-diagnosis of certain conditions.
“There have been a lot of profiteers who have tried to capitalize on people’s needs and I think this is very dangerous,” he said. “In some settings, profiteering companies have set up systems to offer ADHD assessments that are almost always substandard. This is different from not-for-profit setups that adhere to quality standards and regulatory mechanisms.”
Sukhera’s concerns recall the case of Cerebral Inc., a New York state-based virtual care company founded in 2020 that marketed on social media platforms including Instagram and TikTok. Cerebral offered online prescriptions for ADHD drugs among other services and boasted more than 200,000 patients. But as Dani Blum reported in the New York Times, Cerebral was accused in 2023 of pressuring doctors on staff to prescribe stimulants and faced an investigation by state prosecutors into whether it violated the U.S. Controlled Substances Act.
“At the start of the pandemic, regulators relaxed rules around medical prescription of controlled substances,” wrote Blum. “Those changes opened the door for companies to prescribe and market drugs without the protocols that can accompany an in-person visit.”
Access increased – but is it equitable?
Virtual care has been a necessity in rural areas in Ontario since well before the pandemic, although ADHD assessments for children were restricted to in-person appointments prior to 2020.
But ADHD assessment clinics that charge families out-of-pocket for services are only accessible to people with higher incomes. Rural families, many of whom are low income, are unable to afford thousands for private assessments, let alone the other services upsold by providers. If the private clinic/virtual care trend continues to grow unchecked, it may also attract doctors away from the public model of care since they can bill more for services. This could further aggravate the gap in care that lower income people already experience.
This could further aggravate the gap in care that lower income people already experience.
Sukhera says some risks could be addressed by instituting OHIP coverage for services at private clinics (similar to private surgical facilities that offer mixed private/public coverage), but also with safeguards to ensure that profits are reinvested back into the health-care system.
“This would be especially useful for folks who do not have the income, the means to pay out of pocket,” he said.
Concerns of misdiagnosis and over-prescription
Some for-profit companies also benefit financially from diagnosing and issuing prescriptions, as has been suggested in the Cerebral case. If it is cheaper for a clinic to do shorter, virtual appointments and they are also motivated to diagnose and prescribe more, then controls need to be put in place to prevent misdiagnosis.
The problem of misdiagnosis may also be related to the nature of ADHD assessments themselves. University of Strathclyde professor Matthew Smith, author of Hyperactive: The Controversial History of ADHD, notes that since the publication of Diagnostic and Statistical Manual of Mental Disorders in 1980, assessment has typically involved a few hours of parents and patients providing their subjective perspectives on how they experience time, tasks and the world around them.
“It’s often a box-ticking exercise, rather than really learning about the context in which these behaviours exist,” Smith said. “The tendency has been to use a list of yes/no questions which – if enough are answered in the affirmative – lead to a diagnosis. When this is done online or via Zoom, there is even less opportunity to understand the context surrounding behaviour.”
Smith cited a 2023 BBC investigation in which reporter Rory Carson booked an in-person ADHD assessment at a clinic and was found not to have the condition, then had a private online assessment – from a provider on her couch in a tracksuit – and was diagnosed with ADHD after just 45 minutes, for a fee of £685.
What do patients want?
If Canadian regulators can effectively tackle the issue of privatization and the risk of misdiagnosis, there is still another hurdle: not every youth is willing to take part in virtual care.
Jennifer Reesman, a therapist and Training Director for Neuropsychology at the Chesapeake Center for ADHD, Learning & Behavioural Health in Maryland, echoed Sukhera’s concerns about substandard care, cautioning that virtual care is not suitable for some of her young clients who had poor experiences with online education and resist online health care. It can be an emotional issue for pediatric patients who are managing their feelings about the pandemic experience.
“We need to respect what their needs are, not just the needs of the provider,” says Reesman.
In 2020, Ontario opted for virtual care based on the capacity of our health system in a pandemic. Today, with a shortage of doctors, we are still in a crisis of capacity. The success of virtual care may rest on how engaged regulators are with equity issues, such as waitlists and access to care for rural dwellers, and how they resolve ethical problems around standards of care.
Children and youth are a distinct category, which is why we had restrictions on virtual ADHD diagnosis prior to the pandemic. A question remains, then: If we could snap our fingers and have the capacity to provide in-person ADHD care for all children, would we? If the answer to that question is yes, then how can we begin to build our capacity?
This article is republished from healthydebate under a Creative Commons license. Read the original article.
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How they did it: STAT reporters expose how ailing seniors suffer when Medicare Advantage plans use algorithms to deny care
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In a call with a long-time source, what stood out most to STAT reporters Bob Herman and Casey Ross was just how viscerally frustrated and angry the source was about an algorithm used by insurance companies to decide how long patients should stay in a nursing home or rehab facility before being sent home.
The STAT stories had a far-reaching impact:
- The U.S. Senate Committee on Homeland Security and Government Affairs took a rare step of launching a formal investigation into the use of algorithms by the country’s three largest Medicare Advantage insurers.
- Thirty-two House members urged the Centers for Medicare and Medicaid Services to increase the oversight of algorithms that health insurers use to make coverage decisions.
- In a rare step, CMS launched its own investigation into UnitedHealth. It also stiffened its regulations on the use of proprietary algorithms and introduced plans to audit denials across Medicare Advantage plans in 2024.
- Based on STAT’s reporting, Medicare Advantage beneficiaries filed two class-action lawsuits against UnitedHealth and its NaviHealth subsidiary, the maker of the algorithm, and against Humana, another major health insurance company that was also using the algorithm.
- Amid scrutiny, UnitedHealth renamed NaviHealth.
The companies never allowed an on-the-record interview with their executives, but they acknowledged that STAT’s reporting was true, according to the news organization.
Ross and Herman spoke with The Journalist’s Resource about their project and shared the following eight tips.
1. Search public comments on proposed federal rules to find sources.
Herman and Ross knew that the Centers for Medicare and Medicaid Services had put out a request for public comments, asking stakeholders within the Medicare Advantage industry how the system could improve.
There are two main ways to get Medicare coverage: original Medicare, which is a fee-for-service health plan, and Medicare Advantage, which is a type of Medicare health plan offered by private insurance companies that contract with Medicare. Medicare Advantage plans have increasingly become popular in recent years.
Under the Social Security Act, the public has the opportunity to submit comments on Medicare’s proposed national coverage determinations. CMS uses public comments to inform its proposed and final decisions. It responds in detail to all public comments when issuing a final decision.
The reporters began combing through hundreds of public comments attached to a proposed Medicare Advantage rule that was undergoing federal review. NaviHealth, the UnitedHealth subsidiary and the maker of the algorithm, came up in many of the comments, which include the submitters’ information.
“These are screaming all-caps comments to federal regulators about YOU NEED TO SOMETHING ABOUT THIS BECAUSE IT’S DISGUSTING,” Ross says.
“The federal government is proposing rules and regulations all the time,” adds Herman, STAT’s business of health care reporter. “If someone’s going to take the time and effort to comment on them, they must have at least some knowledge of what’s going on. It’s just a great tool for any journalist to use to figure out more and who to contact.”
The reporters also found several attorneys who had complained in the comments. They began reaching out to them, eventually gaining access to confidential documents and intermediaries who put them in touch with patients to show the human impact of the algorithm.
2. Harness the power of the reader submission box.
At the suggestion of an editor, the reporters added a reader submission box at the bottom of their first story, asking them to share their own experiences with Medicare Advantage denials.
The floodgates opened. Hundreds of submissions arrived.
By the end of their first story, Herman and Ross had confidential records and some patients, but they had no internal sources in the companies they were investigating, including Navihealth. The submission box led them to their first internal source.
(Screenshot of STAT’s submission box.) The journalists also combed through LinkedIn and reached out to former and current employees, but the response rate was much lower than what they received via the submission box.
The submission box “is just right there,” Herman says. “People who would want to reach out to us can do it right then and there after they read the story and it’s fresh in their minds.”
3. Mine podcasts relevant to your story.
The reporters weren’t sure if they could get interviews with some of the key figures in the story, including Tom Scully, the former head of the Centers for Medicare and Medicaid Services who drew up the initial plans for NaviHealth years before UnitedHealth acquired it.
But Herman and another colleague had written previously about Scully’s private equity firm and they had found a podcast where he talked about his work. So Herman went back to the podcast — where he discovered Scully had also discussed NaviHealth.
The reporters also used the podcast to get Scully on the phone for an interview.
“So we knew we had a good jumping off point there to be like, ‘OK, you’ve talked about NaviHealth on a podcast, let’s talk about this,’” Herman says. “I think that helped make him more willing to speak with us.”
4. When covering AI initiatives, proceed with caution.
“A source of mine once said to me, ‘AI is not magic,’” Ross says. “People need to just ask questions about it because AI has this aura about it that it’s objective, that it’s accurate, that it’s unquestionable, that it never fails. And that is not true.”
AI is not a neutral, objective machine, Ross says. “It’s based on data that’s fed into it and people need to ask questions about that data.”
He suggests several questions to ask about the data behind AI tools:
- Where does the data come from?
- Who does it represent?
- How is this tool being applied?
- Do the people to whom the tool is being applied match the data on which it was trained? “If racial groups or genders or age of economic situations are not adequately represented in the training set, then there can be an awful lot of bias in the output of the tool and how it’s applied,” Ross says.
- How is the tool applied within the institution? Are people being forced to forsake their judgment and their own ability to do their jobs to follow the algorithm?
5. Localize the story.
More than half of all Medicare beneficiaries have Medicare Advantage and there’s a high likelihood that there are multiple Medicare Advantage plans in every county across the nation.
“So it’s worth looking to see how Medicare Advantage plans are growing in your area,” Herman says.
Finding out about AI use will most likely rely on shoe-leather reporting of speaking with providers, nursing homes and rehab facilities, attorneys and patients in your community, he says. Another source is home health agencies, which may be caring for patients who were kicked out of nursing homes and rehab facilities too soon because of a decision by an algorithm.
The anecdote that opens their first story involves a small regional health insurer in Wisconsin, which was using NaviHealth and a contractor to manage post-acute care services, Ross says.
“It’s happening to people in small communities who have no idea that this insurer they’ve signed up with is using this tool made by this other company that operates nationally,” Ross says.
There are also plenty of other companies like NaviHealth that are being used by Medicare Advantage plans, Herman says. “So it’s understanding which Medicare Advantage plans are being sold in your area and then which post-acute management companies they’re using,” he adds.
Some regional insurers have online documents that show which contractors they use to evaluate post-acute care services.
6. Get familiar with Medicare’s appeals databases
Medicare beneficiaries can contest Medicare Advantage denials through a five-stage process, which can last months to years. The appeals can be filed via the Office of Medicare Hearings and Appeals.
“Between 2020 and 2022, the number of appeals filed to contest Medicare Advantage denials shot up 58%, with nearly 150,000 requests to review a denial filed in 2022, according to a federal database,” Ross and Herman write in their first story. “Federal records show most denials for skilled nursing care are eventually overturned, either by the plan itself or an independent body that adjudicates Medicare appeals.”
There are several sources to find appeals data. Be mindful that the cases themselves are not public to protect patient privacy, but you can find the number of appeals filed and the rationale for decisions.
CMS has two quality improvement organizations, or QIOs, Livanta and Kepro, which are required to file free, publicly-available annual reports, about the cases they handle, Ross says.
Another company, Maximus, a Quality Improvement Contractor, also files reports on prior authorization cases it adjudicates for Medicare. The free annual reports include data on raw numbers of cases and basic information about the percentage denials either overturned or upheld on appeal, Ross explains.
CMS also maintains its own database on appeals for Medicare Part C (Medicare Advantage plans) and Part D, which covers prescription drugs, although the data is not complete, Ross explains.
7. Give your editor regular updates.
“Sprinkle the breadcrumbs in front of your editors,” Ross says.
“If you wrap your editors in the process, you’re more likely to be able to get to the end of [the story] before they say, ‘That’s it! Give me your copy,’” Ross says.
8. Get that first story out.
“You don’t have to know everything before you write that first story,” Ross says. “Because with that first story, if it has credibility and it resonates with people, sources will come forward and sources will continue to come forward.”
Read the stories
Denied by AI: How Medicare Advantage plans use algorithms to cut off care for seniors in need
UnitedHealth pushed employees to follow an algorithm to cut off Medicare patients’ rehab care
UnitedHealth used secret rules to restrict rehab care for seriously ill Medicare Advantage patients
This article first appeared on The Journalist’s Resource and is republished here under a Creative Commons license.
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A Fresh Take On Hypothyroidism
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The Three Rs To Boost Thyroid-Related Energy Levels
This is Dr. Izabella Wentz. She’s a doctor of pharmacology, and after her own diagnosis with Hashimoto’s thyroiditis, she has taken it up as her personal goal to educate others on managing hypothyroidism.
Dr. Wentz is also trained in functional medicine through The Institute for Functional Medicine, Kalish Functional Medicine, and the American Academy of Anti-Aging Medicine. She is a Fellow of the American Society of Consultant Pharmacists, and holds certifications in Medication Therapy Management as well as Advanced Diabetes Care through the American Pharmacists Association. In 2013, she received the Excellence in Innovation Award from the Illinois Pharmacists Association.
Dr. Wentz’s mission
Dr. Wentz was disenchanted by the general medical response to hypothyroidism in three main ways. She tells us:
- Thyroid patients are not diagnosed appropriately.
- For this, she criticises over-reliance on TSH tests that aren’t a reliable marker of thyroid function, especially if you have Hashimoto’s.
- Patients should be better optimized on their medications.
- For this, she criticizes many prescribed drugs that are actually pro-drugs*, that don’t get converted adequately if you have an underactive thyroid.
- Lifestyle interventions are often ignored by mainstream medicine.
- Medicines are great; they truly are. But medicating without adjusting lifestyle can be like painting over the cracks in a crumbling building.
*a “pro-drug” is what it’s called when the drug we take is not the actual drug the body needs, but is a precursor that will get converted to that actual drug we need, inside our body—usually by the liver, but not always. An example in this case is T4, which by definition is a pro-drug and won’t always get correctly converted to the T3 that a thyroid patient needs.
Well that does indeed sound worthy of criticism. But what does she advise instead?
First, she recommends a different diagnostic tool
Instead of (or at least, in addition to) TSH tests, she advises to ask for TPO tests (thyroid peroxidase), and a test for Tg antibodies (thyroglobulin). She says these are elevated for many years before a change in TSH is seen.
Next, identify the root cause and triggers
These can differ from person to person, but in countries that add iodine to salt, that’s often a big factor. And while gluten may or may not be a factor, there’s a strong correlation between celiac disease and Hashimoto’s disease, so it is worth checking too. Same goes for lactose.
By “checking”, here we mean testing eliminating it and seeing whether it makes a difference to energy levels—this can be slow, though, so give it time! It is best to do this under the guidance of a specialist if you can, of course.
Next, get to work on repairing your insides.
Remember we said “this can be slow”? It’s because your insides won’t necessarily bounce back immediately from whatever they’ve been suffering from for what’s likely many years. But, better late than never, and the time will pass anyway, so might as well get going on it.
For this, she recommends a gut-healthy diet with specific dietary interventions for hypothyroidism. Rather than repeat ourselves unduly here, we’ll link to a couple of previous articles of ours, as her recommendations match these:
She also recommends regular blood testing to see if you need supplementary TSH, TPO antibodies, and T3 and T4 hormones—as well as vitamin B12.
Short version
After diagnosis, she recommends the three Rs:
- Remove the causes and triggers of your hypothyroidism, so far as possible
- Repair the damage caused to your body, especially your gut
- Replace the thyroid hormones and related things in which your body has become deficient
Learn more
If you’d like to learn more about this, she offers a resource page, with resources ranging from on-screen information, to books you can get, to links to hook you up with blood tests if you need them, as well as recommended supplements to consider.
She also has a blog, which has an interesting relevant article added weekly.
Enjoy, and take care of yourself!
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- Thyroid patients are not diagnosed appropriately.
The 5 Love Languages Gone Wrong
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Levelling up the 5 love languages
The saying “happy wife; happy life” certainly goes regardless of gender, and if we’re partnered, it’s difficult to thrive in our individual lives if we’re not thriving as a couple. So, with the usual note that mental health is also just health, let’s take a look at getting beyond the basics of a well-known, often clumsily-applied model:
The 5 love languages
You’re probably familiar with “the 5 love languages”, as developed by Dr. Gary Chapman. If not, they are:
- Acts of Service
- Gift-Giving
- Physical Touch
- Quality Time
- Words of Affirmation
The idea is that we each weight these differently, and problems can arise when a couple are “speaking a different language”.
So, is this a basic compatibility test?
It doesn’t have to be!
We can, if we’re aware of each other’s primary love languages, make an effort to do a thing we wouldn’t necessarily do automatically, to ensure they’re loved the way they need to be.
But…
What a lot of people overlook is that we can also have different primary love languages for giving and for receiving. And, missing that can mean that even taking each other’s primarily love languages into account, efforts to make a partner feel loved, or to feel loved oneself, can miss 50% of the time.
For example, I (your writer here today, hi) could be asked my primary love language and respond without hesitation “Acts of Service!” because that’s my go-to for expressing love.
I’m the person who’ll run around bringing drinks, do all the housework, and without being indelicate, will tend towards giving in the bedroom. But…
A partner trying to act on that information to make me feel loved by giving Acts of Service would be doomed to catastrophic failure, because my knee-jerk reaction would be “No, here, let me do that for you!”
So it’s important for partners to ask each other…
- Not: “what’s your primary love language?” ❌
- But: “what’s your primary way of expressing love?” ✅
- And: “which love language makes you feel most loved?” ✅
For what it’s worth, I thrive on Words of Affirmation, so thanks again to everyone who leaves kind feedback on our articles! It lets me know I provided a good Act of Service
So far, so simple, right? You and your partner (or: other person! Because as we’ve just seen, these go for all kinds of dynamics, not just romantic partnerships) need to be aware of each other’s preferred love languages for giving and receiving.
But…
There’s another pitfall that many fall into, and that’s assuming that the other person has the same idea about what a given love language means, when there’s more to clarify.
For example:
- Acts of Service: is it more important that the service be useful, or that it took effort?
- Gift-Giving: is it better that a gift be more expensive, or more thoughtful and personal?
- Physical Touch: what counts here? If we’re shoulder-to-shoulder on the couch, is that physical touch or is something more active needed?
- Quality Time: does it count if we’re both doing our own thing but together in the same room, comfortable in silence together? Or does it need to be a more active and involved activity together? And is it quality time if we’re at a social event together, or does it need to be just us?
- Words of Affirmation: what, exactly, do we need to hear? For romantic partners, “I love you” can often be important, but is there something else we need to hear? Perhaps a “because…”, or perhaps a “so much that…”, or perhaps something else entirely? Does it no longer count if we have to put the words in our partner’s mouth, or is that just good two-way communication?
Bottom line:
There’s a lot more to this than a “What’s your love language?” click-through quiz, but with a little application and good communication, this model can really resolve a lot of would-be problems that can grow from feeling unappreciated or such. And, the same principles go just the same for friends and others as they do for romantic partners.
In short, it’s one of the keys to good interpersonal relationships in general—something critical for our overall well-being!
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Healthy Relationship, Healthy Life
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Only One Kind Of Relationship Promotes Longevity This Much!
One of the well-established keys of a long healthy life is being in a fulfilling relationship. That’s not to say that one can’t be single and happy and fulfilled—one totally can. But statistically, those who live longest, do so in happy, fulfilling, committed relationships.
Note: happy, fulfilling, committed relationships. Less than that won’t do. Your insurance company might care about your marital status for its own sake, but your actual health doesn’t—it’s about the emotional safety and security that a good, healthy, happy, fulfilling relationship offers.
How to keep the “love coals” warm
When “new relationship energy” subsides and we’ve made our way hand-in-hand through the “honeymoon period”, what next? For many, a life of routine. And that’s not intrinsically bad—routine itself can be comforting! But for love to work, according to relational psychologists, it also needs something a little more.
What things? Let’s break it down…
Bids for connection—and responsiveness to same
There’s an oft-quoted story about a person who knew their marriage was over when their spouse wouldn’t come look at their tomatoes. That may seem overblown, but…
When we care about someone, we want to share our life with them. Not just in the sense of cohabitation and taxes, but in the sense of:
- Little moments of joy
- Things we learned
- Things we saw
- Things we did
…and there’s someone we’re first to go to share these things with. And when we do, that’s a “bid for connection”. It’s important that we:
- Make bids for connection frequently
- Respond appropriately to our partner’s bids for connection
Of course, we cannot always give everything our full attention. But whenever we can, we should show as much genuine interest as we can.
Keep asking the important questions
Not just “what shall we have for dinner?”, but:
- “What’s a life dream that you have at the moment?”
- “What are the most important things in life?”
- “What would you regret not doing, if you never got the chance?”
…and so forth. Even after many years with a partner, the answers can sometimes surprise us. Not because we don’t know our partners, but because the answers can change with time, and sometimes we can even surprise ourselves, if it’s a question we haven’t considered for a while.
It’s good to learn and grow like this together—and to keep doing so!
Express gratitude/appreciation
For the little things as well as the big:
- Thank you for staying by my side during life’s storms
- Thank you for bringing me a coffee
- Thank you for taking on these responsibilities with me
- I really appreciate your DIY skills
- I really appreciate your understanding nature
On which note…
Compliment, often and sincerely
Most importantly, compliment things intrinsic to their character, not just peripheral attributes like appearance, and also not just what they do for you.
- You’re such a patient person; I really admire that
- I really hit the jackpot to get someone I can trust so completely as you
- You are the kindest and sweetest soul I have ever encountered in life
- I love that you have such a blend of strength and compassion
- Your unwavering dedication to your personal values makes me so proud
…whatever goes for your partner and how you see them and what you love about them!
Express your needs, and ask about theirs
We’re none of us mind-readers, and it’s easy to languish in “if they really cared, I wouldn’t have to ask”, or conversely, “if they wanted something, they would surely say so”.
Communicate. Effectively. Life is too short to waste in miscommunication and unsaid things!
We covered much more detailed how-tos of this in a previous issue, but good double-whammy of top tier communication is:
- “I need…” / “Please will you…”
- “What do you need?” / “How can I help?”
Touch. Often.
It takes about 20 seconds of sustained contact for oxytocin to take effect, so remember that when you hug your partner, hold hands when walking, or cuddle up the sofa.
Have regular date nights
It doesn’t have to be fancy. A date night can be cooking together, it can be watching a movie together at home. It can be having a scheduled time to each bring a “big question” or five, from what we talked about above!
Most importantly: it’s a planned shared experience where the intent is to enjoy each other’s romantic company, and have a focus on each other. Having a regularly recurring date night, be it the last day of each month, or every second Saturday, or every Friday night, whatever your schedules allow, makes such a big difference to feel you are indeed “dating” and in the full flushes of love—not merely cohabiting pleasantly.
Want ideas?
Check out these:
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Antioxidant Matcha Snack Bars
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The antioxidants in this come not just from the matcha, but also the cacao nibs and chocolate, as well as lots of nutrients from the hazelnuts and cashews. If you’re allergic to nuts, we’ll give you substitutions that will change the nutritional profile (and flavor), but still work perfectly well and be healthy too.
You will need
For the base:
- ⅔ cup roasted hazelnuts (if allergic, substitute dessicated coconut)
- ⅔ cup chopped dates
For the main part:
- 1 cup raw cashews (if allergic, substitute raw coconut, chopped)
- ½ cup almond milk (or your preferred milk of any kind)
- ½ cup cacao nibs
- 2 tbsp lime juice
- 1 tbsp matcha powder
- 1 tbsp maple syrup (omit if you don’t care for sweetness)
For the topping (optional):
- 2oz dark chocolate, melted (and if you like, tempered—but this isn’t necessary; it’ll just make it glossier if you do)
- Spare cacao nibs, chopped nuts, or anything else you might want on there
Method
(we suggest you read everything at least once before doing anything)
1) Blend the base ingredients in a food processor until it has a coarse sticky texture, but isn’t yet a paste or dough.
2) Line a cake pan with baking paper and spread the base mix on the base; press it down to compact it a little and ensure it is flat. If there’s room, put this in the freezer while you do the next bit. If not, the fridge will suffice.
3) Blend the main part ingredients apart from the cacao nibs, until smooth. Stir in the cacao nibs with a spoon.
4) Spread the main part evenly over the base, and allow everything you’ve built (in this recipe, not in life in general) to chill in the fridge for at least 4 hours.
5) Cut it into blocks of the size and shape you want to eat them, and (if adding the optional topping) separate the blocks slightly from each other, before drizzling with the chocolate topping. Put it back in the fridge to cool this too; an hour should be sufficient.
6) Serve!
Enjoy!
Want to learn more?
For those interested in some of the science of what we have going on today:
- Which Tea Is Best, By Science?
- Which Plant Milk?
- Why You Should Diversify Your Nuts!
- Cashew Nuts vs Coconut – Which is Healthier?
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Don’t Forget…
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Learn to Age Gracefully
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Remember – by Dr. Lisa Genova
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Memory is often viewed as one thing—either you have a good memory, or you don’t. At best, a lot of people have a vague idea of selective memory. But, the reality is much more complex—and much more interesting.
Dr. Genova lays out clearly and simply the various different kinds of memory, how they work, and how they fail. Some of these kinds of memory operate on completely different principles than others, and/or in different parts of the brain. And, it’s not just “a memory for faces” or a “memory for names”, nor even “short term vs long term”. There’s working memory, explicit and implicit memory, semantic memory, episodic memory, muscle memory, and more.
However, this is not just an interesting book—it’s also a useful one. Dr. Genova also looks at how we can guard against failing memory in later years, and how we can expand and grow the kinds of memory that are most important to us.
The style of the book is very conversational, and not at all textbook-like. It’s certainly very accessible, and pleasant to read too.
Bottom line: memory is a weird and wonderful thing, and this book shines a clear light on many aspects of it—including how to improve the various different kinds of memory.
Click here to check out Remember (we recommend to do it now before you forget!
Don’t Forget…
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Learn to Age Gracefully
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