
Rebalancing Dopamine (Without “Dopamine Fasting”)
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Rebalancing Dopamine (Without “Dopamine Fasting”)

This is Dr. Anna Lembke. She’s a professor of psychiatry at Stanford, and chief of the Stanford Addiction Medicine Dual Diagnosis Clinic—as well as running her own clinical practice, and serving on the board of an array of state and national addiction-focused organizations.
Today we’re going to look at her work on dopamine management…
Getting off the hedonic treadmill
For any unfamiliar with the term, the “hedonic treadmill” is what happens when we seek pleasure, enjoy the pleasure, the pleasure becomes normalized, and now we need to seek a stronger pleasure to get above our new baseline.
In other words, much like running on a reciprocal treadmill that just gets faster the faster we run.
What Dr. Lembke wants us to know here: pleasure invariably leads to pain
This is not because of some sort of extrinsic moral mandate, nor even in the Buddhist sense. Rather, it is biology.
Pleasure and pain are processed by the same part of the brain, and if we up one, the other will be upped accordingly, to try to keep a balance.
Consequently, if we recklessly seek “highs”, we’re going to hit “lows” soon enough. Whether that’s by drugs, sex, or just dopaminergic habits like social media overuse.
Dr. Lembke’s own poison of choice was trashy romance novels, by the way. But she soon found she needed more, and more, and the same level wasn’t “doing it” for her anymore.
So, should we just give up our pleasures, and do a “dopamine fast”?
Not so fast!
It depends on what they are. Dopamine fasting, per se, does not work. We wrote about this previously:
Short On Dopamine? Science Has The Answer
However, when it comes to our dopaminergic habits, a short period (say, a couple of weeks) of absence of that particular thing can help us re-find our balance, and also, find insight.
Lest that latter sound wishy-washy: this is about realizing how bad an overuse of some dopaminergic activity had become, the better to appreciate it responsibly, going forwards.
So in other words, if your poison is, as in Dr. Lembke’s case, trashy romance novels, you would abstain from them for a couple of weeks, while continuing to enjoy the other pleasures in life uninterrupted.
Substances that create a dependency are a special case
There’s often a popular differentiation between physical addictions (e.g. alcohol) and behavioral addictions (e.g. video games). And that’s fair; physiologically speaking, those may both involve dopamine responses, but are otherwise quite different.
However, there are some substances that are physical addictions that do not create a physical dependence (e.g. sugar), and there are substances that create a physical dependence without being addictive (e.g. many antidepressants)
See also: Addiction and physical dependence are not the same thing
In the case of anything that has created a physical dependence, Dr. Lembke does not recommend trying to go “cold turkey” on that without medical advice and supervision.
Going on the counterattack
Remember what we said about pleasure and pain being processed in the same part of the brain, and each rising to meet the other?
While this mean that seeking pleasure will bring us pain, the inverse is also true.
Don’t worry, she’s not advising us to take up masochism (unless that’s your thing!). But there are very safe healthy ways that we can tip the scales towards pain, ultimately leading to greater happiness.
Cold showers are an example she cites as particularly meritorious.
As a quick aside, we wrote about the other health benefits of these, too:
A Cold Shower A Day Keeps The Doctor Away?
Further reading
Want to know more? You might like her book:
Dopamine Nation: Finding Balance in the Age of Indulgence
Enjoy!
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Citicoline: Better Than Dietary Choline?
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Citicoline: Better Than Dietary Choline?
Citicoline, also known as cytidine diphosphate-choline (or CDP-Choline, to its friends, or cytidine 5′-diphosphocholine if it wants to get fancy) is a dietary supplement that the stomach can metabolize easily for all the brain’s choline needs. What are those needs?
Choline is an essential nutrient. We technically can synthesize it, but only in minute amounts, far less than we need. Choline is a key part of the neurotransmitter acetylcholine, as well as having other functions in other parts of the body.
As for citicoline specifically… it appears to do the job better than dietary sources of choline:
❝Intriguing data, showing that on a molar mass basis citicoline is significantly less toxic than choline, are also analyzed.
It is hypothesized that, compared to choline moiety in other dietary sources such as phosphatidylcholine, choline in citicoline is less prone to conversion to trimethylamine (TMA) and its putative atherogenic N-oxide (TMAO).
Epidemiological studies have suggested that choline supplementation may improve cognitive performance, and for this application citicoline may be safer and more efficacious.❞
Source: Citicoline: A Superior Form of Choline?
Great! What does it do?
What doesn’t it do? When it comes to cognitive function, anyway, citicoline covers a lot of bases.
Short version: it improves just about every way a brain’s healthy functions can be clinically measured. From cognitive improvements in all manner of tests (far beyond just “improves memory” etc; also focus, alertness, verbal fluency, logic, computation, and more), to purely neurological things like curing tinnitus (!), alleviating mobility disorders, and undoing alcohol-related damage.
One of the reasons it’s so wide in its applications, is that it has a knock-on effect to other systems in the brain, including the dopaminergic system.
Long version: Citicoline: pharmacological and clinical review, 2022 update
(if you don’t want to sit down for a long read, we recommend skimming to the charts and figures, which are very elucidating even alone)
Spotlight study in memory
For a quick-reading example of how it helps memory specifically:
Keeping dementia at bay
For many older people looking to improve memory, it’s less a matter of wanting to perform impressive feats of memory, and more a matter of wanting to keep a sharp memory throughout our later years.
Dr. Maria Bonvicini et al. looked into this:
❝We selected seven studies including patients with mild cognitive impairment, Alzheimer’s disease or post-stroke dementia
All the studies showed a positive effect of citicoline on cognitive functions. Six studies could be included in the meta-analysis.
Overall, citicoline improved cognitive status, with pooled standardized mean differences ranging from 0.56 (95% CI: 0.37-0.75) to 1.57 (95% CI: 0.77-2.37) in different sensitivity analyses❞
The researchers concluded “yes”, and yet, called for more studies, and of higher quality. In many such studies, the heterogeneity of the subjects (often, residents of nursing homes) can be as much a problem (unclear whether the results will be applicable to other people in different situations) as it is a strength (fewer confounding variables).
Another team looked at 47 pre-existing reviews, and concluded:
❝The review found that citicoline has been proven to be a useful compound in preventing dementia progression.
Citicoline has a wide range of effects and could be an essential substance in the treatment of many neurological diseases.
Its positive impact on learning and cognitive functions among the healthy population is also worth noting.❞
Source: Application of Citicoline in Neurological Disorders: A Systematic Review
The dopamine bonus
Remember how we said that citicoline has a knock-on effect on other systems, including the dopaminergic system? This means that it’s been studied (and found meritorious) for alleviating symptoms of Parkinson’s disease:
❝Patients with Parkinson’s disease who were taking citicoline had significant improvement in rigidity, akinesia, tremor, handwriting, and speech.
Citicoline allowed effective reduction of levodopa by up to 50%.
Significant improvement in cognitive status evaluation was also noted with citicoline adjunctive therapy.❞
Source: Citicoline as Adjuvant Therapy in Parkinson’s Disease: A Systematic Review
Where to get it?
We don’t sell it, but here’s an example product on Amazon, for your convenience
Enjoy!
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The Meds That Impair Decision-Making
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Impairment to cognitive function is often comorbid with Parkinson’s disease. That is to say: it’s not a symptom of Parkinson’s, but it often occurs in the same people. This may seem natural: after all, both are strongly associated with aging.
However, recent (last month, at time of writing) research has brought to light a very specific way in which medication for Parkinson’s may impair the ability to make sound decisions.
Obviously, this is a big deal, because it can affect healthcare decisions, financial decisions, and more—greatly impacting quality of life.
See also: Age-related differences in financial decision-making and social influence
(in which older people were found more likely to be influenced by the impulsive financial preferences of others than their younger counterparts, when other factors are controlled for)
As for how this pans out when it comes to Parkinson’s meds…
Pramipexole (PPX)
This drug can, due to an overlap in molecular shape, mimic dopamine in the brains of people who don’t have enough—such as those with Parkinson’s disease. This (as you might expect) helps alleviate Parkinson’s symptoms.
However, researchers found that mice treated with PPX and given a touch-screen based gambling game picked the high-risk, high reward option much more often. In the hopes of winning strawberry milkshake (the reward), they got themselves subjected to a lot of blindingly-bright flashing lights (the risk, to which untreated mice were much more averse, as this is very stressful for a mouse).
You may be wondering: did the mice have Parkinson’s?
The answer: kind of; they had been subjected to injections with 6-hydroxydopamine, which damages dopamine-producing neurons similarly to Parkinson’s.
This result was somewhat surprising, because one would expect that a mouse whose depleted dopamine was being mimicked by a stand-in (thus, doing much of the job of dopamine) would be less swayed by the allure of gambling (a high-dopamine activity), since gambling is typically most attractive to those who are desperate to find a crumb of dopamine somewhere.
They did find out why this happened, by the way, the PPX hyperactivated the external globus pallidus (also called GPe, and notwithstanding the name, this is located deep inside the brain). Chemically inhibiting this area of the brain reduced the risk-taking activity of the mice.
This has important implications for Parkinson’s patients, because:
- on an individual level, it means this is a side effect of PPX to be aware of
- on a research-and-development level, it means drugs need to be developed that specifically target the GPe, to avoid/mitigate this side effect.
You can read the study in full here:
Don’t want to get Parkinson’s in the first place?
While nothing is a magic bullet, there are things that can greatly increase or decrease Parkinson’s risk. Here’s a big one, as found recently (last week, at the time of writing):
Air Pollution and Parkinson’s Disease in a Population-Based Study
Also: knowing about its onset sooner rather than later is scary, but beneficial. So, with that in mind…
Recognize The Early Symptoms Of Parkinson’s Disease
Finally, because Parkinson’s disease is theorized to be caused by a dysfunction of alpha-synuclein clearance (much like the dysfunction of beta-amyloid clearance, in the case of Alzheimer’s disease), this means that having a healthy glymphatic system (glial cells doing the same clean-up job as the lymphatic system, but in the brain) is critical:
How To Clean Your Brain (Glymphatic Health Primer)
Take care!
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The Biggest Cause Of Back Pain
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Will Harlow, specialist over-50s physiotherapist, shares the most common cause (and its remedy) in this video:
The seat of the problem
The issue (for most people, anyway) is not in the back itself, nor the core in general, but rather, in the glutes. That is to say: the gluteus maximus, medius, and minimus. They assist in bending forwards (collaborating half-and-half with your back muscles), and help control pelvic alignment while walking.
Sitting for long periods weakens the glutes, causing the back to overcompensate, leading to pain. So, obviously don’t do that, if you can help it. Weak glutes shift the work to your back muscles during bending and walking, increasing strain and—as a result—back pain.
The solution (besides “sit less”) is to do specific exercises to strengthen the glutes. When you do, focus on good form and do not try to push through pain. If the exercises themselves all cause pain, then stop and consult a local physiotherapist to figure out your next step.
With that in mind, the five exercises recommended in this video to strengthen glutes and reduce back pain are:
- Hip abduction (isometric): use a heavy resistance band or belt around legs above the knees, push outwards.
- The clam: lie on your side, bend your knees 90°, and lift your top knee while keeping your body forward. Focus on glute engagement.
- Clam with resistance band: use a light resistance band above your knees and perform the same clam exercise.
- Hip abduction (straight leg): lie on your side, keep legs straight, lift your top leg diagonally backward. Lead with your heel to target your glutes and avoid back strain.
- Hip abduction with resistance band: place a resistance band around your ankles, and lift leg as in the previous exercise.
For more on all these, plus visual demonstrations, enjoy:
Click Here If The Embedded Video Doesn’t Load Automatically!
Want to learn more?
You might also like to read:
- 6 Ways To Look After Your Back
- Strong Curves: A Woman’s Guide To Building A Better Butt And Body – by Bret Contreras & Kellie Davis
- How To Stop Pain From Spreading
Take care!
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Podiatrists Debunk 11 Feet Myths
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Podiatrists Dr. Sarah Haller and Dr. Brad Schaeffer put us on a better path:
Don’t get wrong-footed
We’ll not keep the 11 myths a mystery; they are…
- “You have warts because your feet are dirty.”
False! Warts are caused by a virus, not dirt. Viruses can be picked up from surfaces like yoga mats, pools, gyms, and showers. - “Bunions are caused by wearing heels.”
False! Bunions are genetic deformities where the bone behind the big toe shifts. Heels might worsen them but don’t cause them. - “Cutting the sides of my toenail will prevent an ingrown toenail.”
False! Toenails should be cut straight across. Cutting the sides can make ingrown toenails worse. - “Pedicures gave me toenail fungus.”
Partially true! You can get fungus from many places, but safe, sterile pedicures are generally fine. - “Only athletes get athlete’s foot.”
False! Athlete’s foot is a fungal infection caused by warm, moist environments. Anyone can get it, not just athletes. - “My feet are fine because I trained them to walk in stilettos.”
False! You can get used to stilettos, but they aren’t healthy long-term. They shorten the Achilles tendon and put pressure on the foot. - “You can’t do anything for a broken toe.”
False! Broken toes can be treated and should be checked by a doctor. They may need to be set for proper healing. - “It’s normal for your feet to hurt from standing all day.”
False! Foot pain isn’t normal and can be prevented with proper footwear, support, and compression socks. - “All inserts are the same.”
False! Everyone’s feet are different. Some may benefit from over-the-counter insoles, but others need custom orthotics. - “Sprained ankles are no big deal.”
False! Sprains can damage ligaments and lead to instability or arthritis if untreated. Proper stabilization is essential. - “If I can walk after an injury, I don’t need to see a doctor.”
False! You can still have serious injuries like fractures even if you can walk. Always get checked after an injury.
For more on each of these, enjoy:
Click Here If The Embedded Video Doesn’t Load Automatically!
Want to learn more?
You might also like to read:
Steps For Keeping Your Feet A Healthy Foundation
Take care!
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- “You have warts because your feet are dirty.”
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Professional-Style Dental Cleaning At Home?
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You know the scene: your dentist is rummaging around inside your mouth with an implement that looks like a medieval torture device; you wince at a sudden sharp pain, only to be told “if you flossed, you wouldn’t be bleeding now”.
For most of us, going to the dentist isn’t near the top of our “favorite things to do” list, but it is of course a necessity of (healthy) life.
So, what can we do to minimize suffering in the dentist’s chair?
First, the basics
Of course, good oral hygiene is the absolute baseline, but with so many choices out there, which is best? We examined an array of options in this three-part series:
- Toothpastes & Mouthwashes: Which Help And Which Harm?
- Flossing Without Flossing?
- Less Common Oral Hygiene Options ← we recommend the miswak! Not only does it clean the teeth as well as or better than traditional brushing, but also it changes the composition of saliva to improve the oral microbiome, effectively turning your saliva into a biological mouthwash that kills unwanted microbes and is comfortable for the ones that should be there.
In fact, caring for the composition of one’s saliva, and thus one’s oral microbiome, is so important that we did a main feature on that, a little later:
Make Your Saliva Better For Your Teeth ← this is especially important if you take any meds that affect the composition of your saliva (scroll down to the table of meds). Your medications’ leaflets won’t tell you that it does that directly, but they will list “dry mouth” as one of the potential side effects (and you’ll probably know if you have a medication that gives you a dry mouth).
Next, level up
For this one, we’ll drop some links to some videos we’ve featured (for those who prefer text, worry not, your faithful writer has added text-based overviews):
- How To Regrow Receding Gums
- Tooth Remineralization: How To Heal Your Teeth Naturally
- Tartar Removal At Home & How To Prevent Tartar
Now, that last one sounds slightly more exciting than it is—it is about using chemical processes to gradually lessen the tartar over time, with a six-month timeframe.
So, what if you want to do one better than that?
Finally… Buckle up, this one’s fun
Ok, so “fun” and “dental care” don’t usually go hand-in-hand, and maybe your sense of fun differs from this writer’s, but hey. The thing is, we’re going to get hands-on with dental tools.
Specifically, these dental tools:
👆 these are literally the tools this writer has; if you look in the specula (the round mirror bits), you can see the reflection of the fluffy gray bathrobe I was wearing when I took the picture!
You can get tools like these easily online; here’s an example product on Amazon; do also shop around of course, and we recommend checking the reviews to ensure good quality.
Writer’s story on why I have these: once upon a time, a wisdom tooth came through at 45°, ploughing through the molar next to it, which then needed removing.
However, my teeth have the interesting anatomical quirk that I have hooked/barbed roots, which does not make tooth extraction easy; it had to come out sidewise, and the process was somewhat bungled by an inexperienced dental surgeon.
When the anesthetic wore off, it was the most pain I’ve ever been in in my life.
After that, I wasn’t a very regular returner to the dentist, and in 2013, I fell into a very deep depression for unrelated reasons, and during that period, I got some plaque/tartar buildup on some of my teeth due to lack of care, that then just stayed until I decided to take care of it more recently, which I am happy to say, I’ve now done (my teeth are the happiest and healthiest they’ve ever been), and I’m going to share how, with you.
So, here’s how to do it… First, you’ll need those tools, of course.
You will also want a good quality backlit magnifying mirror. Again, here’s an example product on Amazon ← this is the exact kind this writer has, and it’s very good.
You may be thinking: “wait a minute, this is scary, those are dangerous and I’m not a dentist!”
If so, then a few quick things to bear in mind:
- If you’re not comfortable doing it, don’t do it. As ever, our medical/legal disclaimer applies, and we share information for your interest only, and not as an exhortation to take any particular action. By all means confer with your dentist, too, and see whether they support the idea.
- These things do look scarier than they are once you get used to them. Do you use metal silverware when eating? Technically you could stab yourself with a fork any time, or damage your teeth with it, but when was the last time you did that?
- With regard to manual dexterity, if you have the manual dexterity required to paint your nails, floss your teeth, sew by hand, or write with a pen, then you have the manual dexterity to do this, too.
Now, about the tools:
- Speculum / magnifying speculum: the one with the mirror. This is useful for looking at the backs of teeth.
- Tweezers: the one with the gold grip in the photo above. You probably won’t need to use these, but we’re sure you know how to use tweezers in general.
- Dental explorer: the one with the big wicked-looking hook on one end, and a tiny (almost invisible in the photo) hook on the other end. This is for examining cavities, not for manipulating things. Best leave that to your dentist if you have cavities.
- Dental pick: this is the one to the right of the dental explorer, and it is for cleaning in the crevices between teeth. One end is quite blunt; the other is pointier, and you can choose which end to use depending on what fits into the shape of the crevice between your teeth.
- Dental scraper: this is the one with chisel ends. One end curves very slightly to the left, the other, very slightly to the right. This is for ergonomics depending on which hand you’re using, and which side you’re scraping (you’ll become very aware that your teeth, even if they look straight, curve very slightly at the edges.
You’ll be using these last two for the actual tartar removal, selecting the tool appropriate to cleaning the flat surface of a tooth, or the crevice where the teeth meet (not like flossing! That part, yes, but under no circumstances is this thing going all the way through to the other side, it’s just for getting into to nook that the scraper can’t so easily clean, that’s all).
A word on using metal against your teeth: a scary prospect, initially! However…
While steel is indeed harder than the enamel of your teeth, the enamel of your teeth is much harder than the plaque/tartar/calculus that you will be removing. Therefore, the technique to use is very gently scrape, starting as gently as humanly possible until you get a feel for it.
Unlike the dentist, you will have an advantage here in that you have biofeedback, and bone conduction of the sounds in your mouth, so you can exercise much more restraint than your dentist can. With the correct minimum of pressure, the tool should glide smoothly down enamel, but when it’s scraping tartar, it should make a very fine sandpapery noise.
This is why “or write with a pen” was one of the skills we mentioned earlier; it’s the same thing; you don’t press with a pen so hard that it goes through the paper, so don’t press so hard with the tool that it damages your enamel, that’s all.
Because of the differential in hardness between the tartar and the enamel, it’s really very easy to remove the tartar without harming the enamel, provided one is gentle.
Final word of warning; we’ll repeat: If you’re not comfortable doing it, don’t do it. As ever, our medical/legal disclaimer applies, and we share information for your interest only, and not as an exhortation to take any particular action. By all means confer with your dentist, too, and see whether they support the idea.
Also, while this kind of cleaning can be done safely at home, we recommend against doing anything more complicated than that.
See for example: Can You Repair Your Own Teeth At Home? ← the short answer is “no”, or not beyond tooth remineralization, anyway, and kits that say otherwise are potentially misleading, or stop-gap solutions at best.
One last time: always consult with a professional and get their advice (ours is not advice; it’s just information).
Take care!
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Caffeine: Cognitive Enhancer Or Brain-Wrecker?
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The Two Sides Of Caffeine
We asked you for your health-related opinions on caffeine itself, not necessarily the coffee, tea, energy drinks, etc that might contain it.
We have, by the way previously written about the health effects of coffee and tea specifically:
As for our question about caffeine itself, though, we got the above-depicted, below-described, set of results:
- About 59% said “caffeine is a safe stimulant and cognitive enhancer”
- About 31% said “caffeine is a moderately safe recreational drug”
- About 8% said “caffeine’s addictive properties make it de facto bad”
- One (1) person said “caffeine will leave you a trembling exhausted wreck”
But what does the science say?
Caffeine is addictive: True or False?
True, though one will find occasional academics quibbling the definition. Most of the studies into the mechanisms of caffeine addiction have been conducted on rats, but human studies exist too and caffeine is generally considered addictive for humans, for example:
See also:
Notwithstanding its addictive status, caffeine is otherwise safe: True or False?
True-ish, for most people. Some people with heart conditions or a hypersensitivity to caffeine may find it is not safe for them at all, and for the rest of us, the dose makes the poison. For example:
❝Can too much caffeine kill you? Although quite rare, caffeine can be fatal in cases of overdose; such circumstances are generally not applicable to healthy individuals who typically consume caffeine via beverages such as tea or coffee.❞
this paper, by the way, also includes a good example of academics quibbling the definition of addiction!
Caffeine is a cognitive enhancer: True or False?
True, but only in the case of occasional use. If you are using it all the time, your physiology will normalize it and you will require caffeine in order to function at your normal level. To attain higher than that, once addicted to caffeine, would now require something else.
Read more: Caffeine: benefits and drawbacks for technical performance
Caffeine will leave you a trembling exhausted wreck: True or False?
True or False depending on usage:
- The famously moderate 3–5 cups per day will not, for most people, cause any such problems.
- Using/abusing it to make up for lost sleep (or some other source of fatigue, such as physical exhaustion from exertion), however, is much more likely to run into problems.
In the latter case, caffeine really is the “payday loan” of energy! It’ll give you an adrenal boost now (in return, you must suffer the adrenal dumping later, along with lost energy expended in the adrenaline surge), and also, the tiredness that you thought was gone, was just caffeine’s adenosine-blocking activities temporarily preventing you from being able to perceive the tiredness. So you’ll have to pay that back later, with interest, because of the extra time/exertion too.
Want to make caffeine a little more gentle on your system?
Taking l-theanine alongside caffeine can ameliorate some of caffeine’s less wonderful effects—and as a bonus, l-theanine has some nifty benefits of its own, too:
Enjoy!
Don’t Forget…
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