Tourette’s Syndrome Treatment Options
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It’s Q&A Day at 10almonds!
Have a question or a request? You can always hit “reply” to any of our emails, or use the feedback widget at the bottom!
In cases where we’ve already covered something, we might link to what we wrote before, but will always be happy to revisit any of our topics again in the future too—there’s always more to say!
As ever: if the question/request can be answered briefly, we’ll do it here in our Q&A Thursday edition. If not, we’ll make a main feature of it shortly afterwards!
So, no question/request too big or small
❝Is there anything special that might help someone with Tourette’s syndrome?❞
There are of course a lot of different manifestations of Tourette’s syndrome, and some people’s tics may be far more problematic to themselves and/or others, while some may be quite mild and just something to work around.
It’s an interesting topic for sure, so we’ll perhaps do a main feature (probably also covering the related-and-sometimes-overlapping OCD umbrella rather than making it hyperspecific to Tourette’s), but meanwhile, you might consider some of these options:
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Mineral-Rich Mung Bean Pancakes
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Mung beans are rich in an assortment of minerals, especially iron, copper, phosphorus, and magnesium. They’re also full of protein and fiber! What better way to make pancakes healthy?
You will need
- ½ cup dried green mung beans
- ½ cup chopped fresh parsley
- ½ cup chopped fresh dill
- ¼ cup uncooked wholegrain rice
- ¼ cup nutritional yeast
- 1 tsp MSG, or 2 tsp low-sodium salt
- 2 green onions, finely sliced
- 1 tbsp extra virgin olive oil
Method
(we suggest you read everything at least once before doing anything)
1) Soak the mung beans and rice together overnight.
2) Drain and rinse, and blend them in a blender with ¼ cup of water, to the consistency of regular pancake batter, adding more water (sparingly) if necessary.
3) Transfer to a bowl and add the rest of the ingredients except for the olive oil, which latter you can now heat in a skillet over a medium-high heat.
4) Add a few spoonfuls of batter to the pan, depending on how big you want the pancakes to be. Cook on both sides until you get a golden-brown crust, and repeat for the rest of the pancakes.
5) Serve! As these are savory pancakes, you might consider serving them with a little salad—tomatoes, olives, and cucumbers go especially well.
Enjoy!
Want to learn more?
For those interested in some of the science of what we have going on today:
- Why You’re Probably Not Getting Enough Fiber (And How To Fix It)
- What’s The Deal With MSG?
- All About Olive Oils: Is “Extra Virgin” Worth It?
Take care!
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What Weston Price Got Right (And Wrong)
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Weston Price: What Stood The Test of Time?
This is Dr. Weston Price, a dentist. You may guess from the photo, or perhaps already knew, his work is not new in 2023. We usually feature current health experts here, but we’re taking a day to do a blast from the past, because his ideas endure today, and inform a lot of people’s health views. So, he’s a good one to at least know about.
What was his deal?
Dr. Price (1870–1948) wanted to study focal infection theory—the idea that repairing root canals allowed bacterial infections that caused everything from heart disease to arthritis. His solution was that the teeth should be extracted instead.
This theory was popular in the 1920s, was challenged in the 1930s, ignored in the 1940s (the world was a bit busy), and by broad medical consensus anyway, rejected in the 1950s. But, while it was being challenged in the 1930s, Dr. Price decided to find more evidence for its support.
The result was his famous world tour of peoples living traditional lifestyles without the influence of “modern” diet. His findings, and the conclusions he drew from them, extended to far more than just dental health.
What did he find?
Dr. Price found that people living traditional lifestyles, with their traditional diets based on locally-sourced foods, had much better overall health. Of course, he was a dentist and not a general practitioner, so aside from examining their teeth, he largely relied on self-reported diagnoses of illness, or lack thereof.
In short: he found that people in places without modern medical institutions had fewer diagnoses of disease. From this, he concluded that incidence of disease was much lower.
There was also an unexamined element of survivorship bias—an undiagnosed disease is more likely to be fatal, and he questioned only living people, which skewed the stats rather. Nor did he examine infant mortality rate nor adult life expectancy, both of which were not great.
Was it all useless, then?
Actually no! He did hit upon some observations that have stood the test of time:
- He correctly concluded that modern diets with sugar and white flour were ruinous to the health.
- He correctly concluded that locally-sourced food, and grass-fed in the case of pastoral farming, tended to have much more nutritional value than the mass-produced results of intensive farming.
- He correctly concluded that many modern preservation methods robbed foods of their nutrients.
- He correctly concluded that many grains and seeds are more nutritions when fermented/soaked/sprouted.
About that “locally-sourced food”: the reason locally-sourced food tends to be more nutritious is that it has required less in the way of preservation for a long trip around the world, and will also tend to be fresher.
On the other hand, this does mean a lot of the foods that Dr. Price recommends are very much subject to availability. It may well be true that the Inuit people do not eat a lot of fruit and veg (which mostly do not grow there), but if you live in Nevada, maybe locally-sourced whale fat is just as difficult to find.
One person’s “this fatty organ meat contains the vitamin C we need” may be another person’s “that’s great; I have an apple tree in my garden though”.
Want to learn more?
Dr. Price’s most influential work is his magnum opus, “Nutrition and Physical Degeneration”. It’s a fascinating book in its historical context, but do be warned, it was written by a rich white man in 1939 and the writing is as racist as you might expect. Even when making favourable comparisons, the tone is very much “and here is what these savages are doing well”.
If you don’t fancy reading all that, here are two other sources about Weston Price’s work and conclusions, presented for balance:
- The Weston A. Price Foundation (Official Website)
- Weston Price’s Appalling Legacy (Science-Based Medicine.org)
Enjoy!
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Brain Wash – by Dr. David Perlmutter, Dr. Austin Perlmutter, and Kristen Loberg
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You may be familiar with the lead author of this book, Dr. David Perlmutter, as a big name in the world of preventative healthcare. A lot of his work has focused specifically on carbohydrate metabolism, and he is as associated with grains and he is with brains. This book focuses on the latter.
Dr. Perlmutter et al. take a methodical look at all that is ailing our brains in this modern world, and systematically lay out a plan for improving each aspect.
The advice is far from just dietary, though the chapter on diet takes a clear stance:
❝The food you eat and the beverages you drink change your emotions, your thoughts, and the way you perceive the world❞
The style is explanatory, and the book can be read comfortably as a “sit down and read it cover to cover” book; it’s an enjoyable, informative, and useful read.
Bottom line: if you’d like to give your brain a gentle overhaul, this is the one-stop-shop book to give you the tools to do just that.
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The Four Pillar Plan – by Dr. Rangan Chatterjee
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Dr. Rangan Chatterjee, a medical doctor, felt frustrated with how many doctors in his field focus on treating the symptoms of disease, rather than the cause. Sometimes, of course, treating the symptom is necessary too! But neglecting the cause is a recipe for long-term woes.
What he does differently is take lifestyle as a foundation, and even that, he does differently than many authors on the topic. How so, you may wonder?
Rather than look first at exercise and diet, he starts with “relax”. His rationale is reasonable: diving straight in with marathon training or a whole new diet plan can be unsustainable without this as a foundation to fall back on.
Many sources look first at exercise (because it can be a very simple “prescription”) before diet (often more complex)… but how does one exercise well with the wrong fuel in the tank? So Dr. Chatterjee’s titular “Four Pillars” come in the following order:
- Relax
- Eat
- Move
- Sleep
He also goes for “move” rather than “exercise” as the focus here is more on minimizing time spent sitting, and thus involving a lot of much more frequent gentle activities… rather than intensive training programs and the like.
And as for sleep? Yes, that comes last because—no matter how important it is—the other things are easier to directly control. After all, one can improve conditions for sleep, but one cannot simply choose to sleep better! So with the other three things covered first, good sleep is the fourth and final thing to fall into place.
All in all, this is a great book to cut through the catch-22 problem of lifestyle factors negatively impacting each other.
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Traveling To Die: The Latest Form of Medical Tourism
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In the 18 months after Francine Milano was diagnosed with a recurrence of the ovarian cancer she thought she’d beaten 20 years ago, she traveled twice from her home in Pennsylvania to Vermont. She went not to ski, hike, or leaf-peep, but to arrange to die.
“I really wanted to take control over how I left this world,” said the 61-year-old who lives in Lancaster. “I decided that this was an option for me.”
Dying with medical assistance wasn’t an option when Milano learned in early 2023 that her disease was incurable. At that point, she would have had to travel to Switzerland — or live in the District of Columbia or one of the 10 states where medical aid in dying was legal.
But Vermont lifted its residency requirement in May 2023, followed by Oregon two months later. (Montana effectively allows aid in dying through a 2009 court decision, but that ruling doesn’t spell out rules around residency. And though New York and California recently considered legislation that would allow out-of-staters to secure aid in dying, neither provision passed.)
Despite the limited options and the challenges — such as finding doctors in a new state, figuring out where to die, and traveling when too sick to walk to the next room, let alone climb into a car — dozens have made the trek to the two states that have opened their doors to terminally ill nonresidents seeking aid in dying.
At least 26 people have traveled to Vermont to die, representing nearly 25% of the reported assisted deaths in the state from May 2023 through this June, according to the Vermont Department of Health. In Oregon, 23 out-of-state residents died using medical assistance in 2023, just over 6% of the state total, according to the Oregon Health Authority.
Oncologist Charles Blanke, whose clinic in Portland is devoted to end-of-life care, said he thinks that Oregon’s total is likely an undercount and he expects the numbers to grow. Over the past year, he said, he’s seen two to four out-of-state patients a week — about one-quarter of his practice — and fielded calls from across the U.S., including New York, the Carolinas, Florida, and “tons from Texas.” But just because patients are willing to travel doesn’t mean it’s easy or that they get their desired outcome.
“The law is pretty strict about what has to be done,” Blanke said.
As in other states that allow what some call physician-assisted death or assisted suicide, Oregon and Vermont require patients to be assessed by two doctors. Patients must have less than six months to live, be mentally and cognitively sound, and be physically able to ingest the drugs to end their lives. Charts and records must be reviewed in the state; neglecting to do so constitutes practicing medicine out of state, which violates medical licensing requirements. For the same reason, the patients must be in the state for the initial exam, when they request the drugs, and when they ingest them.
State legislatures impose those restrictions as safeguards — to balance the rights of patients seeking aid in dying with a legislative imperative not to pass laws that are harmful to anyone, said Peg Sandeen, CEO of the group Death With Dignity. Like many aid-in-dying advocates, however, she said such rules create undue burdens for people who are already suffering.
Diana Barnard, a Vermont palliative care physician, said some patients cannot even come for their appointments. “They end up being sick or not feeling like traveling, so there’s rescheduling involved,” she said. “It’s asking people to use a significant part of their energy to come here when they really deserve to have the option closer to home.”
Those opposed to aid in dying include religious groups that say taking a life is immoral, and medical practitioners who argue their job is to make people more comfortable at the end of life, not to end the life itself.
Anthropologist Anita Hannig, who interviewed dozens of terminally ill patients while researching her 2022 book, “The Day I Die: The Untold Story of Assisted Dying in America,” said she doesn’t expect federal legislation to settle the issue anytime soon. As the Supreme Court did with abortion in 2022, it ruled assisted dying to be a states’ rights issue in 1997.
During the 2023-24 legislative sessions, 19 states (including Milano’s home state of Pennsylvania) considered aid-in-dying legislation, according to the advocacy group Compassion & Choices. Delaware was the sole state to pass it, but the governor has yet to act on it.
Sandeen said that many states initially pass restrictive laws — requiring 21-day wait times and psychiatric evaluations, for instance — only to eventually repeal provisions that prove unduly onerous. That makes her optimistic that more states will eventually follow Vermont and Oregon, she said.
Milano would have preferred to travel to neighboring New Jersey, where aid in dying has been legal since 2019, but its residency requirement made that a nonstarter. And though Oregon has more providers than the largely rural state of Vermont, Milano opted for the nine-hour car ride to Burlington because it was less physically and financially draining than a cross-country trip.
The logistics were key because Milano knew she’d have to return. When she traveled to Vermont in May 2023 with her husband and her brother, she wasn’t near death. She figured that the next time she was in Vermont, it would be to request the medication. Then she’d have to wait 15 days to receive it.
The waiting period is standard to ensure that a person has what Barnard calls “thoughtful time to contemplate the decision,” although she said most have done that long before. Some states have shortened the period or, like Oregon, have a waiver option.
That waiting period can be hard on patients, on top of being away from their health care team, home, and family. Blanke said he has seen as many as 25 relatives attend the death of an Oregon resident, but out-of-staters usually bring only one person. And while finding a place to die can be a problem for Oregonians who are in care homes or hospitals that prohibit aid in dying, it’s especially challenging for nonresidents.
When Oregon lifted its residency requirement, Blanke advertised on Craigslist and used the results to compile a list of short-term accommodations, including Airbnbs, willing to allow patients to die there. Nonprofits in states with aid-in-dying laws also maintain such lists, Sandeen said.
Milano hasn’t gotten to the point where she needs to find a place to take the meds and end her life. In fact, because she had a relatively healthy year after her first trip to Vermont, she let her six-month approval period lapse.
In June, though, she headed back to open another six-month window. This time, she went with a girlfriend who has a camper van. They drove six hours to cross the state border, stopping at a playground and gift shop before sitting in a parking lot where Milano had a Zoom appointment with her doctors rather than driving three more hours to Burlington to meet in person.
“I don’t know if they do GPS tracking or IP address kind of stuff, but I would have been afraid not to be honest,” she said.
That’s not all that scares her. She worries she’ll be too sick to return to Vermont when she is ready to die. And, even if she can get there, she wonders whether she’ll have the courage to take the medication. About one-third of people approved for assisted death don’t follow through, Blanke said. For them, it’s often enough to know they have the meds — the control — to end their lives when they want.
Milano said she is grateful she has that power now while she’s still healthy enough to travel and enjoy life. “I just wish more people had the option,” she said.
KFF Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF—an independent source of health policy research, polling, and journalism. Learn more about KFF.
Subscribe to KFF Health News’ free Morning Briefing.
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Hardcore Self Help: F**k Anxiety – by Dr. Robert Duff
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We’ve reviewed other anxiety books before, so what makes this one different? Mostly, it’s the style.
Aside from swearing approximately once every two lines (so you might want to skip this one if that would bother you), Dr. Duff’s writing is very down-to-earth in other ways too, making it unpretentiously comfortable and accessible without failing to draw upon the wealth of good-practice, evidence-based advice he has to offer.
To that end, he talks about what anxiety is and isn’t, and goes over various approaches, explaining them in a “about” fashion, and also a “how to” fashion, covering areas such as CBT, somatic therapies, social support, when talk therapy is most likely to help.
The book is a quick read (a modest 74 pages), and it’s refreshing that it hasn’t been padded unnecessarily, unlike a lot of books that could have been a fraction of the size without losing value.
Bottom line: if you (or perhaps someone you care about) would benefit from a straight-to-the-point, no-BS approach to dealing with anxiety (that’s actually evidence-based, not just a “get over it” dismissal), then this is the book for you.
Click here to check out Hardcore Self Help: F**k Anxiety, and indeed do just that!
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