Uric Acid’s Extensive Health Impact (And How To Lower It)
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Uric Acid’s Extensive Health Impact (And How To Lower It)
This is Dr. David Perlmutter. He’s a medical doctor, and a Fellow of the American College of Nutrition. He’s a member of the Editorial Board for the Journal of Alzheimer’s Disease, and has been widely published in many other peer-reviewed journals.
What does he want us to know?
He wants us to know about the health risks of uric acid (not something popularly talked about so much!), and how to reduce it.
First: what is it? Uric acid is a substance we make in our own body. However, unlike most substances we make in our body, we have negligible use for it—it’s largely a waste product, usually excreted in urine.
However, if we get too much, it can build up (and crystallize), becoming such things as kidney stones, or causing painful inflammation if it shows up in the joints, as in gout.
More seriously (unpleasant as kidney stones and gout may be), this inflammation can have a knock-on effect triggering (or worsening) other inflammatory conditions, ranging from non-alcoholic fatty liver disease, to arthritis, to dementia, and even heart problems. See for example:
- David Perlmutter | Uric Acid and Cognitive Decline
- American Heart Association | Uric acid linked to later risk for irregular heart rhythm
- World Journal of Gastroenterology | The role of uric acid in non-alcoholic steatohepatitis development
How can we reduce our uric acid levels?
Uric acid is produced when we metabolize purine nucleotides, which are found in many kinds of food. We can therefore reduce our uric acid levels by reducing our purine intake, as well as things that mess up our liver’s ability to detoxify things. Offsetting the values for confounding variables (such as fiber content, or phytochemicals that mitigate the harm), the worst offenders include…
Liver-debilitating things:
- Alcohol (especially beer)
- High-fructose corn syrup (and other fructose-containing things that aren’t actual fruit)
- Other refined sugars
- Wheat / white flour products (this is why beer is worse than wine, for example; it’s a double-vector hit)
Purine-rich things:
- Red meats and game
- Organ meats
- Oily fish, and seafood (great for some things; not great for this)
Some beans and legumes are also high in purines, but much like real fruit has a neutral or positive effect on blood sugar health despite its fructose content, the beans and legumes that are high in purines, also contain phytochemicals that help lower uric acid levels, so have a beneficial effect.
Eggs (consumed in moderation) and tart cherries have a uric-acid lowering effect.
Water is important for all aspects of health, and doubly important for this.
Hydrate well!
Lifestyle matters beyond diet
The main key here is metabolic health, so Dr. Perlmutter advises the uncontroversial lifestyle choices of moderate exercise and good sleep, as well as (more critically) intermittent fasting. We wrote previously on other things that can benefit liver health:
…in this case, that means the liver gets a break to recuperate (something it’s very good at, but does need to get a chance to do), which means that while you’re not giving it something new to do, it can quickly catch up on any backlog, and then tackle any new things fresh, next time you start eating.
Want to know more about this from Dr. Perlmutter?
You might like his article:
An Integrated Plan for Lowering Uric Acid ← more than we had room for here; he also talks about extra things to include in your diet/supplementation regime for beneficial effects!
And/or his book:
…on which much of today’s main feature was based.
Take care!
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Ketogenic Diet: Burning Fat Or Burning Out?
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In Wednesday’s newsletter, we asked you for your opinion of the keto diet, and got the above-depicted, below-described set of responses:
- About 45% said “It has its benefits, but they don’t outweigh the risks”
- About 31% said “It is a good, evidence-based way to lose weight, be energized, and live healthily”
- About 24% said “It is a woeful fad diet and a fast-track to ruining one’s overall health”
So what does the science say?
First, what is the ketogenic diet?
There are two different stories here:
- Per science, it’s a medical diet designed to help treat refractory epilepsy in children.
- Per popular lore, it’s an energizing weight loss diet for Instagrammers and YouTubers.
Can it be both? The answer is: yes, but with some serious caveats, which we’ll cover over the course of today’s feature.
The ketogenic diet works by forcing the body to burn fat for energy: True or False?
True! This is why it helps for children with refractory epilepsy. By starving the body (including the brain) of glucose, the liver must convert fat into fatty acids and ketones, which latter the brain (and indeed the rest of the body) can now use for energy instead of glucose, thus avoiding one of the the main triggers of refractory epilepsy in children.
See: The Ketogenic Diet: One Decade Later | Pediatrics
Even the pediatric epilepsy studies, however, conclude it does have unwanted side effects, such as kidney stones, constipation, high cholesterol, and acidosis:
Source: Dietary Therapies for Epilepsy
The ketogenic diet is good for weight loss: True or False?
True! Insofar as it does cause weight loss, often rapidly. Of course, so do diarrhea and vomiting, but these are not usually held to be healthy methods of weight loss. As for keto, a team of researchers recently concluded:
❝As obesity rates in the populace keep rising, dietary fads such as the ketogenic diet are gaining traction.
Although they could help with weight loss, this study had a notable observation of severe hypercholesterolemia and increased risk of atherosclerotic cardiovascular disease among the ketogenic diet participants.❞
~ Dr. Shadan Khdher et al.
On which note…
The ketogenic diet is bad for the heart: True or False?
True! As Dr. Joanna Popiolek-Kalisz concluded recently:
❝In terms of cardiovascular mortality, the low-carb pattern is more beneficial than very low-carbohydrate (including the ketogenic diet). There is still scarce evidence comparing ketogenic to the Mediterranean diet.
Other safety concerns in cardiovascular patients such as adverse events related to ketosis, fat-free mass loss, or potential pharmacological interactions should be also taken into consideration in future research.❞
~ Dr. Joanna Popiolek-Kalisz
Read in full: Ketogenic diet and cardiovascular risk: state of the art review
The ketogenic diet is good for short-term weight loss, but not long-term maintenance: True or False?
True! Again, insofar as it works in the short term. It’s not the healthiest way to lose weight and we don’t recommend it, but it did does indeed precipitate short-term weight loss. Those benefits are not typically observed for longer than a short time, though, as the above-linked paper mentions:
❝The ketogenic diet does not fulfill the criteria of a healthy diet. It presents the potential for rapid short-term reduction of body mass, triglycerides level, Hb1Ac, and blood pressure.
Its efficacy for weight loss and the above-mentioned metabolic changes is not significant in long-term observations.❞
~ Ibid.
The ketogenic diet is a good, evidence-based way to lose weight, be energized, and live healthily: True or False?
False, simply, as you may have gathered from the above, but we’ve barely scratched the surface in terms of the risks.
That said, as mentioned, it will induce short-term weight loss, and as for being energized, typically there is a slump-spike-slump in energy:
- At first, the body is running out of glucose, and so naturally feels weak and tired.
- Next, the body enters ketosis, and so feels energized and enlivened ← this is the part where the popular enthusiastic reviews come from
- Then, the body starts experiencing all the longer-term problems associated with lacking carbohydrates and having an overabundance of fat, so becomes gradually more sick and tired.
Because of this, the signs of symptoms of being in ketosis (aside from: measurably increased ketones in blood, breath, and urine) are listed as:
- Bad breath
- Weight loss
- Appetite loss
- Increased focus and energy
- Increased fatigue and irritability
- Digestive issues
- Insomnia
The slump-spike-slump we mentioned is the reason for the seemingly contradictory symptoms of increased energy and increased fatigue—you get one and then the other.
Here’s a small but illustrative study, made clearer by its participants being a demographic whose energy levels are most strongly affected by dietary factors:
The ketogenic diet is a woeful fad diet and a fast-track to ruining one’s overall health: True or False?
True, subjectively in the first part, as it’s a little harsher than we usually go for in tone, though it has been called a fad diet in scientific literature. The latter part (ruining one’s overall health) is observably true.
One major problem is incidental-but-serious, which is that a low-carb diet is typically a de facto low-fiber diet, which is naturally bad for the gut and heart.
Other things are more specific to the keto diet, such as the problems with the kidneys:
However, kidney stones aren’t the worst of the problems:
Is Losing Weight Worth Losing Your Kidney: Keto Diet Resulting in Renal Failure
We’re running out of space and the risks associated with the keto diet are many, but for example even in the short term, it already increases osteoporosis risk:
❝Markers of bone modeling/remodeling were impaired after short-term low-carbohydrate high-fat diet, and only one marker of resorption recovered after acute carbohydrate restoration❞
~ Dr. Ida Heikura et al.
A Short-Term Ketogenic Diet Impairs Markers of Bone Health in Response to Exercise
Want a healthier diet?
We recommend the Mediterranean diet.
See also: Four Ways To Upgrade The Mediterranean
(the above is about keeping to the Mediterranean diet, while tweaking one’s choices within it for a specific extra health focus such as an anti-inflammatory upgrade, a heart-healthy upgrade, a gut-healthy upgrade, and a brain-healthy upgrade)
Enjoy!
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What’s Your Ikigai?
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Ikigai: A Closer Look
We’ve mentioned ikigai from time to time, usually when discussing the characteristics associated with Blue Zone centenarians, for example as number 5 of…
It’s about finding one’s “purpose”. Not merely a function, but what actually drives you in life. And, if Japanese studies can be extrapolated to the rest of the world, it has a significant and large impact on mortality (other factors being controlled for); not having a sense of ikigai is associated with an approximately 47%* increase in 7-year mortality risk in the categories of cardiovascular disease and external cause mortality:
Sense of life worth living (ikigai) and mortality in Japan: Ohsaki Study
*we did a lot of averaging and fuzzy math to get this figure; the link will show you the full stats though!
In case that huge (n=43,391) study didn’t convince you, here’s another comparably-sized (n=43,117) one that found similarly, albeit framing the numbers the other way around, i.e. a comparable decrease in mortality risk for having a sense of ikigai:
This study was even longer (12 years rather than 7), so the fact that it found pretty much the same results the 7-year study we cited just before is quite compelling evidence. Again, multivariate hazard ratios were adjusted for age, BMI, drinking and smoking status, physical activity, sleep duration, education, occupation, marital status, perceived mental stress, and medical history—so all these things were effectively controlled for statistically.
Three kinds of ikigai
There are three principal kinds of ikigai:
- Social ikigai: for example, a caring role in the family or community, volunteer work, teaching
- Asocial ikigai: for example, a solitary practice of self-discipline, spirituality, or study without any particular intent to teach others
- Antisocial ikigai: for example, a strong desire to outlive an enemy, or to harm a person or group that one hates
You may be thinking: wait, aren’t those last things bad?
And… Maybe! But ikigai is not a matter of morality or even about “warm fuzzy feelings”. The fact is, having a sense of purpose increases longevity regardless of moral implications or niceness.
Nevertheless, for obvious reasons there is a lot more focus on the first two categories (social and asocial), and of those, especially the first category (social), because on a social level, “we all do well when we all do well”.
We exemplified them above, but they can be defined:
- Social: working for the betterment of society
- Asocial: working for the betterment of oneself
Of course, for many people, the same ikigai may cover both of those—often somebody who excels at something for its own sake and/but shares it with others to enrich their lives also, for example a teacher, an artist, a scientist, etc.
For it to cover both, however, requires that both parts of it are genuinely part of their feeling of ikigai, and not merely unintended consequences.
For example, a piano teacher who loves music in general and the piano in particular, and would gladly spend every waking moment studying/practising/performing, but hates having to teach it, but needs to pay the bills so teaches it anyway, cannot be said to be living any kind of social ikigai there, just asocial. And in fact, if teaching the piano is causing them to not have the time or energy to pursue it for its own sake, they might not even be living any ikigai at all.
One other thing to watch out for
There is one last stumbling block, which is that while we can find ikigai, we can also lose it! Examples of this may include:
- A professional whose job is their ikigai, until they face mandatory retirement or are otherwise unable to continue their work (perhaps due to disability, for example)
- A parent whose full-time-parent role is their ikigai, until their children leave for school, university, life in general
- A married person whose “devoted spouse” role is their ikigai, until their partner dies
For this reason, people of any age can have a “crisis of identity” that’s actually more of a “crisis of purpose”.
There are two ways of handling this:
- Have a back-up ikigai ready! For example, if your profession is your ikigai, maybe you have a hobby waiting in the wings, that you can smoothly jump ship to upon retirement.
- Embrace the fluidity of life! Sometimes, things don’t happen the way we expect. Sometimes life’s surprises can trip us up; sometimes they can leave us a sobbing wreck. But so long as life continues, there is an opportunity to pick ourselves up and decide where to go from that point. Note that this is not fatalism, by the way, it doesn’t have to be “this bad thing happened so that we could find this good thing, so really it was a good thing all along”. Rather, it can equally readily be “well, we absolutely did not want that bad thing to happen, but since it did, now we shall take it this way from here”.
For more on developing/maintaining psychological resilience in the face of life’s less welcome adversities, see:
Psychological Resilience Training
…and:
Putting The Abs Into Absurdity ← do not underestimate the power of this one
Take care!
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Fully Present – by Dr. Susan Smalley and Diana Winston
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“The Science and the Art of…” tends to be a bit of a fuzzy obfuscation, but in this case, it’s accurate, especially in this presentation. The authors are, indeed, a scientist and an artist—and both practitioners, meeting in the middle.
As such, we get the clinical insights of a researcher and professor of psychiatry, and the grounded-yet-spiritual insights of an erstwhile Buddhist nun.
While the book is pop psychology in essence, the format is much more that of a textbook than a self-help book. Will it be useful for helping yourself anyway, though? Yes, absolutely, if you apply the information contained within.
Don’t be fooled into thinking that a textbook format makes it dry, though—the writing is very compelling, and you’ll find yourself turning pages eagerly. There’s no time like the present, after all!
Bottom line: if you find the scientific evidence-base for the usefulness of mindfulness appealing, but find a lot of guides a little fluffy, this one is perfectly balanced—and very well written, too.
Click here to check out Fully Present, bring yourself into the moment, always!
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Related Posts
How To Boost Your Memory Immediately (Without Supplements)
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How To Boost Your Memory (Without Supplements)
While we do recommend having a good diet and taking advantage of various supplements that have been found to help memory, that only gets so much mileage. With that in mind…
First, how good is your memory? Take This 2-Minute Online Test
Now, that was a test of short term memory, which tends to be the most impactful in our everyday life.
It’s the difference between “I remember the address of the house where I grew up” (long-term memory) and “what did I come to this room to do?” (short-term memory / working memory)
First tip:
When you want to remember something, take a moment to notice the details. You can’t have a madeleine moment years later if you wolfed down the madeleines so urgently they barely touched the sides.
This goes for more than just food, of course. And when facing the prospect of age-related memory loss in particular, people tend to be afraid not of forgetting their PIN code, but their cherished memories of loved ones. So… Cherish them, now! You’ll struggle to cherish them later if you don’t cherish them now. Notice the little details as though you were a painter looking at a scene for painting. Involve more senses than just sight, too!
If it’s important, relive it. Relive it now, relive it tomorrow. Rehearsal is important to memory, and each time you relive a memory, the deeper it gets written into your long-term memory until it becomes indelible to all but literal brain damage.
Second tip:
Tell the story of it to someone else. Or imagine telling it to someone else! (You brain can’t tell the difference)
And you know how it goes… Once you’ve told a story a few times, you’ll never forget it later. Isn’t your life a story worth telling?
Many people approach memory like they’re studying for a test. Don’t. Approach it like you’re preparing to tell a story, or give a performance. We are storytelling creatures at heart, whether or not we realize it.
What do you do when you find yourself in a room and wonder why you went there? (We’ve all been there!) You might look around for clues, but if that doesn’t immediately serve, your fallback will be retracing your steps. Literally, physically, if needs be, but at least mentally. The story of how you got there is easier to remember than the smallest bit of pure information.
What about when there’s no real story to tell, but we still need to remember something?
Make up a story. Did you ever play the game “My granny went to market” as a child?
If not, it’s a collaborative memory game in which players take turns adding items to a list, “My granny went to market and bought eggs”, My granny went to market and bought eggs and milk”, “my granny went to market and bought eggs and milk and flour” (is she making a cake?), “my granny went to market and bought eggs and milk and flour and shoe polish” (what image came to mind? Use that) “my granny went to market and bought eggs and milk and flour and shoe polish and tea” (continue building the story in your head), and so on.
When we actually go shopping, if we don’t have a written list we may rely on the simple story of “what I’m going to cook for dinner” and walking ourselves through that story to ensure we get the things we need.
This is because our memory thrives (and depends!) on connections. Literal synapse connections in the brain, and conceptual contextual connections in your mind. The more connections, the better the memory.
Now imagine a story: “I went to Stonehenge, but in the background was a twin-peaked mountain blue. I packed a red suitcase, placing a conch shell inside it, when suddenly I heard a trombone, and…” Ring any bells? These are example items from the memory test earlier, though of course you may have seen different things in a different order.
So next time you want to remember things, don’t study as though for a test. Prepare to tell a story!
Try going through the test again, but this time, ignore their instructions because we’re going to use the test differently than intended (we’re rebels like that). Don’t rush, and don’t worry about the score this time (or even whether or not you saw a given image previously), but instead, build a story as you go. We’re willing to bet that after it, you can probably recite most of the images you saw in their correct order with fair confidence.
Here’s the link again: Take The Same Test, But This Time Make It Story-Worthy!
Again, ignore what it says about your score this time, because we weren’t doing that this time around. Instead, list the things you saw.
What you were just able to list was the result of you doing story-telling with random zero-context images while under time pressure.
Imagine what you can do with actual meaningful memories of your ongoing life, people you meet, conversations you have!
Just… Take the time to smell the roses, then rehearse the story you’ll tell about them. That memory will swiftly become as strong as any memory can be, and quickly get worked into your long-term memory for the rest of your days.
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Thai Green Curry With Crispy Tofu Balls
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Diversity is key here, with a wide range of mostly plants, offering an even wider range of phytochemical benefits:
You will need
- 7 oz firm tofu
- 1 oz cashew nuts (don’t soak them)
- 1 tbsp nutritional yeast
- 1 tsp turmeric
- 4 scallions, sliced
- 7 oz mangetout
- 7 oz fermented red cabbage (i.e., from a jar)
- 1 cup coconut milk
- Juice of ½ lime
- 2 tsp light soy sauce
- 1 handful fresh cilantro, or if you have the “cilantro tastes like soap” gene, then parsley
- 1 handful fresh basil
- 1 green chili, chopped (multiply per heat preference)
- 1″ piece fresh ginger, roughly chopped
- ¼ bulb garlic, crushed
- 1 tsp red chili flakes
- 1 tsp black pepper, coarse ground
- ½ tsp MSG or 1 tsp low-sodium salt
- Avocado oil for frying
- Recommended, to serve: lime wedges
- Recommended, to serve: your carbohydrate of choice, such as soba noodles or perhaps our Tasty Versatile Rice.
Method
(we suggest you read everything at least once before doing anything)
1) Heat the oven to 350℉ / 180℃, and bake the cashews on a baking tray for about 8 minutes until lightly toasted. Remove from the oven and allow to cool a little.
2) Combine the nuts, tofu, nutritional yeast, turmeric, and scallions in a food processor, and process until the ingredients begin to clump together. Shape into about 20 small balls.
3) Heat some oil in a skillet and fry the tofu balls, jiggling frequently to get all sides; it should take about 5 minutes to see them lightly browned. Set aside.
4) Combine the coconut milk, lime juice, soy sauce, cilantro/parsley, basil, scallions, green chili, ginger, garlic, and MSG/salt in a high-speed blender, and blend until a smooth liquid.
5) Transfer the liquid to a saucepan, and bring to the boil. Reduce the heat, add the mangetout, and simmer for about 5 minutes to reduce slightly. Stir in the red chili flakes and black pepper.
6) Serve with your preferred carbohydrate, adding the fermented red cabbage and the crispy tofu balls you set aside, along with any garnish you might like to add.
Enjoy!
Want to learn more?
For those interested in some of the science of what we have going on today:
- Capsaicin For Weight Loss And Against Inflammation
- Ginger Does A Lot More Than You Think
- Why Curcumin (Turmeric) Is Worth Its Weight In Gold
- The Many Health Benefits Of Garlic
- Black Pepper’s Impressive Anti-Cancer Arsenal (And More)
- Making Friends With Your Gut (You Can Thank Us Later)
- What’s Your Plant Diversity Score? ← a score of 8.25 for this dish, not counting whatever carbs you might add. Remember, herbs/spices* count for ¼ of a point each!
*but not MSG or salt, as while they may in culinary terms get lumped in with spices, they are of course not plants. Nor is nutritional yeast (nor any other yeast, for that matter). However, mushrooms (not seen in this recipe, though to be honest they would be a respectable addition) would get included for a whole point per mushroom type, since while they are not technically plants but fungi, the nutritional profile is plantlike.
Take care!
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How Useful Are Our Dreams
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What’s In A Dream?
We were recently asked:
❝I have a question or a suggestion for coverage in your “Psychology Sunday”. Dreams: their relevance, meanings ( if any) interpretations? I just wondered what the modern psychological opinions are about dreams in general.❞
~ 10almonds subscriber
There are two main schools of thought, and one main effort to reconcile those two. The third one hasn’t quite caught on so far as to be considered a “school of thought” yet though.
The Top-Down Model (Psychoanalysts)
Psychoanalysts broadly follow the theories of Freud, or at least evolved from there. Freud was demonstrably wrong about very many things. Most of his theories have been debunked and ditched—hence the charitable “or at least evolved from there” phrasing when it comes to modern psychoanalytic schools of thought. Perhaps another day, we’ll go into all the ways Freud went wrong. However, for today, one thing he wasn’t bad at…
According to Freud, our dreams reveal our subconscious desires and fears, sometimes directly and sometimes dressed in metaphor.
Examples of literal representations might be:
- sex dreams (revealing our subconscious desires; perhaps consciously we had not thought about that person that way, or had not considered that sex act desirable)
- getting killed and dying (revealing our subconscious fear of death, not something most people give a lot of conscious thought to most of the time)
Examples of metaphorical representations might be:
- dreams of childhood (revealing our subconscious desires to feel safe and nurtured, or perhaps something else depending on the nature of the dream; maybe a return to innocence, or a clean slate)
- dreams of being pursued (revealing our subconscious fear of bad consequences of our actions/inactions, for example, responsibilities to which we have not attended, debts are a good example for many people; or social contact where the ball was left in our court and we dropped it, that kind of thing)
One can read all kinds of guides to dream symbology, and learn such arcane lore as “if you dream of your teeth crumbling, you have financial worries”, but the truth is that “this thing means that other thing” symbolic equations are not only highly personal, but also incredibly culture-bound.
For example:
- To one person, bees could be a symbol of feeling plagued by uncountable small threats; to another, they could be a symbol of abundance, or of teamwork
- One culture’s “crow as an omen of death” is another culture’s “crow as a symbol of wisdom”
- For that matter, in some cultures, white means purity; in others, it means death.
Even such classically Freudian things as dreaming of one’s mother and/or father (in whatever context) will be strongly informed by one’s own waking-world relationship (or lack thereof) with same. Even in Freud’s own psychoanalysis, the “mother” for the sake of such analysis was the person who nurtured, and the “father” was the person who drew the nurturer’s attention away, so they could be switched gender roles, or even different people entirely than one’s parents.
The only real way to know what, if anything, your dreams are trying to tell you, is to ask yourself. You can do that…
- by reflection and personal interrogation (see for example: The Easiest Way To Take Up Journaling)
- or by externalising parts of your subconscious (as in Internal Family Systems therapy)
- or by talking directly to your subconscious where it is, by means of lucid dreaming.
The idea with lucid dreaming is that since any dream character is a facet of your subconscious generated by your own mind, by talking to that character you can ask questions directly of your subconscious (the popular 2010 movie “Inception” was actually quite accurate in this regard, by the way).
To read more about how to do this kind of self-therapy through lucid dreaming, you might want to check out this book we reviewed previously; it is the go-to book of lucid dreaming enthusiasts, and will honestly give you everything you need in one go:
Lucid Dreaming: A Concise Guide to Awakening in Your Dreams and in Your Life – by Dr. Stephen LaBerge
The Bottom-Up Model (Neuroscientists)
This will take a lot less writing, because it’s practically a null hypothesis (i.e., the simplest default assumption before considering any additional evidence that might support or refute it; usually some variant of “nothing unusual going on here”).
The Bottom-Up model holds that our brains run regular maintenance cycles during REM sleep (a biological equivalent of defragging a computer), and the brain interprets these pieces of information flying by and, because of the mind’s tendency to look for patterns, fills in the rest (much like how modern generative AI can “expand” a source image to create more of the same and fill in the blanks), resulting in the often narratively wacky, but ultimately random, vivid hallucinations that we call dreams.
The Hybrid Model (per Cartwright, 2012)
This is really just one woman’s vision, but it’s an incredibly compelling one, that takes the Bottom-Up model and asks “what if we did all that bio-stuff, and then our subconscious mind influenced the interpretation of the random patterns, to create dreams that are subjectively meaningful, and thus do indeed represent our subconscious?
It’s best explained in her own words, though, so it’s time for another book recommendation (we’ve reviewed this one before, too):
Enjoy!
Don’t Forget…
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Learn to Age Gracefully
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