Tips for using PDPHelper

This AEP is our third year of using PDPHelper. The following are some tips to help us do accurate searches for you on Medicare.gov.

Step 1

Please enter your name, phone, email address, your zip code, and your county of residence. Some zip codes span multiple counties, and that’s why we request your county of residence. This means where your residence sits.

For example, if you have a Post Office box in Three Forks, MT, that’s in Gallatin County. Let’s say you live off Highway 287 in Broadwater County. Please enter “Broadwater” in the field.

Next, please list your top pharmacy choices. Next, we ask you if you would use Walmart, Walgreens, or a mail order pharmacy if that will save you money.

Step 2

In this section only, enter in pills, capsules, or tablets. Liquids, gels, creams, insulin, eye drops, patches, etc. are in the next steps.

Enter the name of your prescription, the dose, the quantity you buy, and this is the quantity you buy per month, every two months, every three months, or every twelve months. If you take something as needed, estimate how many pills you buy and how often you buy it. For example: 30 pills every 3 months.

Example #1—Betty takes two, 500 mg metformin tablets every day. She buys 60 every month.

Name of Prescription: Enter metformin

Dosage: Enter 500 mg

Quantity: Enter 60

Frequency: Enter month

Example #2—John take hydrocodone/apap, 325/10 mg, as needed for back pain. Some days he takes none but other days he takes two or three. He estimates he takes around 45 per month

Name of Prescription: Enter hydrocodone/apap

Dosage: Enter 325/10 mg

Quantity: Enter 45

Frequency: Enter month

Step 3

The section is for Insulin, Inhalers and Nebulizers

Example #3—Alice uses insulin. She checks “yes”, and she enters her information as follows:

Name of insulin: Lantus solostar

Size: 3 mL

Quantity: 5 pack or just 5

Frequency: per 2 months

Example #4—Alice uses Advair. She checks “yes” for the category, “Do you use any inhalers or nebulizers?” She enters her information as follows:

Name of inhaler: Advair

Size: 250/50

Quantity: 1

Frequency: 1 month

Step 4

This final step is for Eye Drops. Gels, Creams, Lotions or Salves, and Other Prescriptions.

Example #5—Mary uses eye drops. She checks “yes” for this category and fills in the information. Please do NOT attempt to say “2 drops per eye each day.” We need to know the SIZE of the bottle, usually 2.5 mL, 5 mL, 10 mL or 15mL.

Name of eye drops: Latanoprost SOL 0.005%

Size: 2.5 mL

Quantity: 1

Frequency: 1 month

When finished, please hit the submit button.

The Hacking of the American Mind Report #5—The Descent into Hades

Background: Chapter 5 and 6 are the final chapters of Part 2 which deals with reward, dopamine, and addiction. Lustig’s writing is fairly technical; I’ll do my best to summarize his explanations into layman’s language.

Lustig begins the chapter by explaining that there’s a price to be paid for reward. It used to be in terms of dollars, but now it’s measured in neurons. Substances, sugar for example, that trigger a dopamine response are now cheap. It’s not a special once-a-year treat. The dopamine receptors in our brains are fragile. Although they like to be “tickled,” these receptors don’t want to be bludgeoned to death.

If you open the dopamine floodgates repeatedly, these neurons have some fail-safe methods built-in to protect themselves.

The over-stimulation of these cells (neurons) leads to cell damage or death, termed excitotoxicity.

My Comments: Dr Russell Blaylock has written a book titled Excitotoxins: The Taste That Kills. You can guess the main theme of his book. Various forms of sugar as well as artificial sweeteners such as aspartame (Equal) and sucralose (Splenda) are toxic substances to critical parts of our brains.

The Firing Squad

Chronic stimulation of your neurons results in cell death, and that’s not good for you. Your brain would continue to get fried. However, nature has provided you some protection against this process, notice some protection.

Ligand (molecules that bind to receptors such as dopamine or cortisol) almost uniformly down regulate their own receptors all over the body.

Put another way, the receptors don’t work as well. The cells don’t respond as well. You need more to get less.

Lustig calls this tolerance. The receiving neuron is becoming tolerant to the excessive stimulus. He says that this occurrence is both good and bad. It’s good because your neurons aren’t dead. It’s bad because you are going to need more of the substance to get the same reward.

My comments: Instead of one doughnut, it’s two or three. Instead of one beer, it’s multiple cans or bottles.

Continuing: Lustig says that tolerance is when a chemical binds to a receptor. This is also true with pharmaceutical drugs. The problem comes in when the stimulations overstimulates the neurons.

Pickling Your Brain

He says that every substance and behavior that drives up your reward triggers will just as quickly drive down your reward receptors. He cites the alcoholic that seemingly can consume more booze than a non-alcoholic as his liver metabolizes the alcohol faster than the non-alcoholic. He explains that this is the reason why drug addicts can easily overdose. First, they are in a period of abstinence, maybe due to treatment or being in jail. Next, they resume with their previous dose, but they no longer have the same level of tolerance. Then they overdose, and for some, it’s fatal.

In essence, he’s saying that one is literally burning up his neurons, and that he’ll never reach the same level or reward as before. He just doesn’t have the machinery to do so, ever! Lusting describes the motto of those in recovery from illicit substances: Once a cucumber becomes a pickle, it never will be a cucumber again.

He cites another problem, and that is withdrawal. Changes in your neurons has occurred. The acute cessation of many of these substances leads to withdrawal. Lustig says that the withdrawal symptoms can be from caffeine, alcohol, narcotics, and tranquilizers. He describes various symptoms in detail.

There can also be emotional withdrawal from cocaine, marijuana, and ecstasy. These symptoms include anxiety, restlessness, irritability, insomnia, headaches, poor concentration, depression, and social isolation. Tolerance and withdrawal are the classic two-headed hydra of the definition of addiction.

Lustig discusses how want turns into need for the addict. The addict will turn to crime to get money to get his fix, and this often includes harming family members.

Are Addictive Behaviors Really Addictive?

Lustig then segues to discussing whether or not behaviors, such as gambling, are addictive. He cited the American Psychological Association (APA) which said that for decades behaviors were not addictive. The reason for their stance was that since the criteria for addiction was both tolerance and withdrawal, there was lack of withdrawal if the behavior ceased. The APA has since changed its position in saying that behaviors can be addictive in certain circumstances.

Addiction Transfer

What happens if a person can’t get his favorite fix? Lustig points out that if a person’s dopamine pump is primed, it’s waiting to be fired, for something, anything. He says that people abstaining from one substance will frequently become users of another substance. He describes smoke filled rooms of AA meetings.

The Real Thing

Lustig recounts the story of John Pemberton, an Atlanta pharmacist. By 1886 he invented a formula using carbonation, and this concoction later became known as Coca Cola. Pemberton placed his first ad for his new carbonated drink in the Atlanta Journal. People came to his pharmacy to imbibe. The pharmacy had special equipment to carbonize the beverage, and this became known as the soda fountain.

My comments: I can remember back in the 1950s visiting the soda fountain at the old Thrifty Drug Store in Burbank, California. There were the stools for the customers, and you could order burgers, fries, malts, and of course, soda pop. The new Thrifty built in the 1960s on an adjacent lot phased out the old soda fountain. I always wondered why a pharmacy had a “soda fountain.” Now I know. It was a carry-over from the late 1800s. Wasam’s Drug in Clarkston, Washington still has their soda fountain that caters to the morning coffee crowd.

Continuing: Pemberton had Civil War injuries which resulted in him becoming a morphine addict following the war. To wean himself off his morphine addiction, he developed a concoction which included cocaine, alcohol, caffeine, and sugar. As Lustig puts it, these were four weaker dopamine/reward drugs, to take the place of one very strong one. Pemberton mixed those four with carbonated water.

Due to the growing temperance movement in the South following the war, Pemberton removed the alcohol from his formula., Due to being sick and penniless, he sold his formula to an Atlanta businessman by the name of Asa Candler for a paltry $2,500. Candler later developed Pemberton’s concoction into the most famous brand in the world. Pemberton died that same year, sick, in pain, and still addicted to morphine. Lustig points out that none of the sordid story of John Pemberton is revealed at the Coca Cola museum in Atlanta.

The federal government required the removal of cocaine from Coca Cola in 1903 leaving just the sugar and caffeine. Did that scuttle Candler’s carbonated drink? No, the two remaining substances were still enough to maintain the hook! Lustig asks a rhetorical question: Why do you think Starbucks sells Frappuccinos?

My comment: No wonder Lustig mentioned Frappuccinos. Depending if they use regular cream or fat-free “cream”, this beverage has about 60 to 90% of its calories from sugar!

Continuing: Coca Cola is in every country in the world except for North Korea. Lustig says that Coca Cola is the most recognized brand on the globe and for good reason:

It’s a delivery vehicle that mainlines two addictive compounds straight to your nucleus accumbens. Sugar just happens to be the cheapest of our many substances of abuse. But all of those substances do essentially the same thing. By driving dopamine release, they all acutely drive reward, and in the process, they drive consumption. Yet, when taken to extreme, every stimulator of reward can result in addiction.

Cost of addictive substances:

  • Heroin or cocaine: You need lots of cash
  • Alcohol and nicotine: You need an I.D.
  • Sugar: You need a quarter or a cookie from Grandma

Lustig describes sugar as the cheap thrill and the reward that everyone on the planet is exposed to and the reward that’s affordable.

Everyone’s an addict, all your relatives are pushers. And it’s only one of two addictive substances that are legal and generally available. (the other one being caffeine). That’s why soda is such a big seller; it’s two addictive substances in one.

My Comments: I can personally testify that sugar is addictive as I became addicted to it an adolescent. Oh yes, I’ve gone through the cravings of wanting something sweet. Fortunately, I abused my health when I was young, and hopefully there have been no long-lasting effects from my past carelessness. The deceptive thing is that many sugar addicts don’t realize they are addicted, or they are in denial. Saying that I have a “sweet tooth” is just hiding that fact that I have a sugar addiction.

Sadly, many seniors are addicted to sugar, and it plays havoc with their health. Gary Taubes in his YouTube video, The Case Against Sugar, speaks of obesity, type two diabetes, heart disease, strokes, cancer, etc. as all being a subset of insulin resistance.

If you recognize that you are addicted to sugar and want to do something about it, there are several excellent self-help videos on YouTube. Simply enter “Breaking a sugar addiction” into your YouTube search window. Here’s a terrific one for starters, 3 Ways To Stop Your Sugar Cravings That Are Keeping You Fat. Here’s another by Dr. Axe, How to Kill Your Sugar Addiction Naturally. It’s superb. Good luck! End

Medical Savings Account: A ‘New’ Type of a Medicare Advantage Plan

The Medical Savings Account (MSA) type of Medicare advantage plan has existed previously, but it will be new for many people. This plan is available in selected states including Montana, Utah, and Wyoming but not yet in Idaho, Oregon, or Washington. Before we delve into the mechanics of how the MSA plan works, let’s review the types of Medicare advantage (MA) plans.

Health Maintenance Organization (HMO): Members use a designated network of doctors. With some exceptions, it is not intended to be used out-of-network.

Preferred Provider Organization (PPO): Members have lower co-pays if they use in-network doctors, but they have the flexibility go out-of-network.

Private Fee for Service (PFFS): Members can use any doctor that accepts the terms and conditions of the plan. When MA plans ramped up in 2006, most plans were PFFS. As the years rolled on, the marketplace evolved in that most MA plans transitioned to either HMO or PPO plans. PFFS plans have virtually disappeared from the marketplace.

MA plans can be MA plans only, or they can be MAPD, which means that they have a prescription benefit incorporated into the plan.

There’s one more important distinction to make. If you have either an HMO or PPO Medicare advantage plan and also want prescription coverage, it must be built into your MA plan. That means that you have an MAPD plan.

If you have a PFFS MA plan without drug coverage, or an MSA plan, you have the option to add a separate, stand-alone Prescription Drug Plan (PDP). If you have an MAPD, whether is be of the PPO or HMO variety and decide to switch to an MSA plan, you will need to pick up a stand-alone PDP, as MSA plans do NOT have prescription plans built into them.

How does the MSA plan work?

The following description is generic, as the numbers I’m using for example purposes only. They are NOT specific to any given MSA plan, but rather they are to illustrate how an MSA plan works. The name of our fictitious company is Acme Health Plans or AHP for short.

Qualification: Your must be on Medicare Parts A and B and live in a county where the plan is offered.

Premium: The plans are typically zero premium.

Savings account amount: The plan deposits $2,400 into your medical savings account. Remember, this is NOT the actual amount of any given plan, but rather It is for illustrative purposes only.

Deductible: $7,400—Again, this is an illustrative number only and not the amount of any given MSA plan.

Let’s say you are starting your new plan January 1, 2019. AHP deposits $2,400 into your MSA debit card account. You can go to any doctor that accepts your plan. There are no networks. You can use your plan in-state or out-of-state.

Your doctor bills AHP, and that bill comes back to you, along with your explanation of benefits, and you pay it out of your debit card account. Let’s say Medicare approved $100 for your office visit. The $100 that you paid counts towards your deductible.

Let’s say that you have exhausted your $2,400 debit account. Now you are the hook for the next $5,000 out of your own pocket for medical expenses until you reach your $7,400 deductible. Once you have met your deductible, AHP pays 100% of your Medicare approved health care expenses for the remainder of the year. The cycle resets at the beginning of the year with a new deductible and a new deposit into your MSA debit card account.

Potential downside of the MSA plan: Yes, you could be out of pocket $5,000, and that will not be acceptable for many people. In summary, AHP fronts you $2,400. From $2,400 to $7,400 you are on you own.

Other important questions

Do I lose whatever remains in my debit account at the end of year? No. Any remaining balance accumulates on a year by year basis. It’s NOT a “use it or lose it” program.

If I leave the plan after two or three years, does AHP take back my debit account? No. The funds are yours. You can continue to use them for qualified medical expenses. (see below) There may be an administrative fee on your debit account after you have left the plan.

Can I use my funds for things that Medicare doesn’t cover such as dental or vision? Yes. You can use your funds for IRS qualified medical expenses (QMEs).

Examples of QMEs:

  • Dental
  • Vison
  • Co-pays for your prescriptions
  • Hearing aids
  • Long term care expenses

Paying for your prescription plan premium from you debit account is not a QME.

Can I drop a Medicare supplement plan and sign up for an MSA plan? Yes. Make sure that you notify your Medicare supplement company that you are leaving their plan.

If I sign up for an MSA plan, can I choose a prescription plan of my choice? Yes. Remember, the MSA plan does not have a prescription benefit.

If I have another MA plan, can I switch to an MSA plan? Yes. Remember, if your MA plan is an MAPD, you will also need to pick up a stand-alone prescription plan to maintain your drug coverage.

Conclusion

Assuming you live in a state where the MSA plan is offered, you will have to determine if the plan is right for you. Consider the pros and cons. Please contact us for further information. End

Watch Out for These Financial Scams in Retirement

By Marc Lichtenfeld, Chief Income Strategist, The Oxford Club

“Grandma,” the voice on the line said desperately. “I need help.” My mother rubbed the sleep from her eyes. It was 3 a.m.

“What’s wrong?” she asked.

“I’m in trouble. I was arrested and need money for bail.”

“Good, I hope you stay there!” my mother boomed and hung up.

My mom is not callous. She’d do anything to help her grandchild out of a bad situation. Fortunately, she has enough sense to know that a) my son was not arrested and b) it wasn’t his voice on the phone.

Unfortunately. not everyone is as sensible as my mother. And this scam has gotten a lot of grandparents to wire “bail money” (often to foreign accounts) with the plea “Please don’t tell Mom or Dad.”

Question of the Week    

It seems like at least once a week my phone rings with some swindle. Seniors tend to be the targets of lots of rip-offs.

Someone my mother knows got scammed out of more than $90,000 in the Nigerian Prince scam, where someone claims to be a prince from Africa who will pay you a hefty fee for help moving millions of dollars out of the country. All they need is your bank account number and other identifying information.

The sad thing is that these scams work… And they work well. Last year, American seniors were scammed out of $36.5 billion.

Here are a few scams you should be aware of so that you don’t become a victim.

Fake IRS: Someone calls you claiming to be from the IRS and says you owe money that needs to be paid right away or you face arrest.

The IRS will NEVER call you about unpaid taxes. Nor will they send an email. If you owe taxes, you will receive a letter in the mail.

If you do in fact owe taxes, you write a check made out to “U.S. Treasury.” That’s it. No wiring money to an account. While you can file and pay electronically with your tax returns, send a check if you receive a letter saying you owe taxes.

Microsoft Calls: I get this one all the time. The caller claims to be from Microsoft or Microsoft Windows and says they’ve found a virus on your computer that they’ll help fix. The caller ID may even say Microsoft or some other official-sounding name.

Scammers like these will offer to help you fix the problem for a fee. They may ask for bank account information. But beware: They could put a harmful virus on your computer even if you just go to the website they give you.

These guys are persistent. Don’t engage with them. (Note that Microsoft does not make unsolicited calls to help you fix your computer.)

My Comments: A client reported this sad tale to me (Lance) when she called to set up a new bank draft for her Medicare plan.

Shirley McGiver lives in Moose City, MT.* About six months ago she received a call concerning a problem with her computer. The earnest caller suggested that he could remedy the problem by allowing him to remote into her computer. He tricked her into giving him and his cronies access.  Bad mistake! She just gave them the keys to the kingdom!

The scammers zeroed in on her passwords for her banking information and proceeded to empty her checking account. Fortunately, with the help of her bank, Shirley was able retrieve her lost funds, however, this was done with a tremendous amount of hassle.

She had to open a new account and change all of her automatic deductions such as her Medicare supplement premium. Then, of course, she had had to deal with the Social Security Administration to have them re-direct her SS deposit to her new account. The entire affair cost her hours on the phone, tons of frustration, and who knows how much added stress in her life.

There are also the hard-to-get rid of pop-ups that attempt to trick you into a similar situation. Bottom line: If anyone calls you on an unsolicited basis offering help with your “computer problem,” treat it as an encounter with a rattling rattlesnake that’s ready to strike. *Some details were changed to protect the identity of the victim.

This leads to scam #3, phishing.

Continuing with Marc Lichtenfeld’s article:

Phishing: This is an easy one to fall for because the scam looks like an official email from someone you may do business with, often a big-name bank. Sometimes the message is marked urgent and states that you need to take action right away by clicking on a link to go to the bank’s website.

Unfortunately, it’s not the bank’s website. These sites will likely ask you to input your bank information or put a keystroke-tracking virus on your computer. This will allow the scammers to get your user IDs or passwords to your various accounts.

I never click through an email from my bank or other businesses. I’ll always type the bank’s URL in my browser and then navigate to the appropriate page. It may take an extra few seconds, but it will protect you from this type of scam.

Stolen Debit Card: This is a new one I’ve come across. It’s ingenious. It happened to my mother-in-law, but fortunately my wife shut it down before any money was lost.

With scams like these, you get a call from a representative of your bank at a local (but not too local) branch claiming that someone with your last name withdrew several thousand dollars from your account with a debit card. The caller then says they thought it was suspicious, so they called the police, who are holding them at the branch right now. You just need to verify the debit card is in your possession by reading the caller your card number and pin.

If you hesitate, the caller tells you that the police will have no choice but to release the person if you don’t give the branch the information, and that you’ll be on the hook for whatever money they withdrew.

Keep in mind, credit card companies will occasionally contact you with questions about suspicious activity on your card. But they will never ask you for your card number.

Here are a few tips to avoid falling victim to a scam:

  • Never give your credit or debit card number, or bank or personal information to anyone unless you initiate the call.
  • Never click on a link in an email from a bank, especially if the email claims that you need to do so urgently.
  • Don’t answer calls unless you recognize the number, even if it says the name of your bank. If it’s urgent, they’ll leave a message.

No one is giving you lots of money to help them move money out of a country. You did not win the lottery or a sweepstakes, and even if you did, there are never any fees associated with claiming your winnings.

You worked hard for your money. A comfortable retirement is dependent on watching your expenditures. Don’t get tricked into giving it away. End

Pain and Inflammation: Natural Painkillers without the Adverse Side Effects

By Dr. Al Sears

Even before I went to medical school, I worked with college athletes. And by far, the biggest complaint was joint pain.

While everyone else was using non-steroidal anti-inflammatory drugs (NSAIDs) like Motrin, Advil and Aleve, I was giving my athletes real hope with an ancient secret. And now, modern scientists are catching on.

A new study in Italy gathered 52 otherwise healthy young rugby players. They all had acute knee pain and inflammation. The players were given either a placebo or an extract of Indian frankincense (Boswellia serrata). Ed: For more information, please click here, here, and here.

After just four weeks, the players taking the Boswellia had a significant reduction in pain and inflammation compared to standard treatments. They could walk farther without pain. They had less damage to their joints, tendons and muscles. And they needed fewer drugs or doctor’s visits.1

But this natural painkiller isn’t only for athletes. Joint pain can be just as debilitating for you and me. And, these days, orthopedic surgeons are quick to cut for joint injuries. More than a million Americans have joint replacement surgery every year.

And Big Pharma’s opioid drugs are dangerous. They have a very high risk of addiction and abuse. Even Ibuprofen has a black box warning about increased risks of heart attack and stroke.

As you know, I use nature’s remedies, like frankincense to relieve the pain and inflammation of any joint aches or injuries. It’s an ancient remedy that goes back 5,000 years.

In Biblical times, it was more highly prized than gold. You probably know it as one of the gifts the three Magi brought to the infant Jesus on the first Christmas.

This resin comes from a tree native to India. It’s one of the most effective treatments I’ve found for arthritis and joint pain. And it doesn’t have the adverse side effects of drugs.

In another large study, researchers followed 440 arthritis patients for six months. They found that frankincense relieved pain as effectively as painkiller drugs. It also significantly improved knee function.2

Boswellia works in many different ways. It contains enzymes that block prostaglandin e2 (PGe2). This hormone-like chemical is produced by the body in response to an injury. It makes blood vessels dilate and expand. This causes the injured area to become swollen and arthritic.

But by directly attacking PGe2, frankincense stops inflammation before it starts.

Frankincense also contains boswellic acid. This compound is a potent inhibitor of 5-lipoxygenase (5-LOX), an enzyme responsible for inflammation. Knocking out 5-LOX enzymes helps prevent inflammation and pain.

Look for a Boswellia serrata supplement standardized to at least 65% boswellic acids. I recommend taking 400 mg three times a day.

Frankincense is also available as an essential oil. You can place a drop or two under your tongue. Or dilute a drop in a glass of water or a teaspoon of honey. I also like to mix frankincense oil with coconut oil and rub it right onto a sore joint.

Boswellia is not the only painkiller in nature’s medicine cabinet. There are additional natural ways to relieve joint pain and inflammation.

Protect Your Joints with These 3 Natural Painkillers

  1. First, try holy basil (Ocimum sanctum linn). This herb has a long and ancient history of treating arthritis pain. It contains dozens of nutrients that reduce inflammation.3 One of the most powerful is called ursolic acid. It inhibits the inflammatory COX-2 enzyme. Clinical studies prove holy basil relieves pain and reduces inflammation.
  2. You can buy holy basil tea at most health food stores or on the Internet. Holy basil capsules are also for sale online. Make sure the product you’re buying has at least 2.5% ursolic acid to get the anti-inflammatory effect. I suggest 150 mg three or four times a day.
  3. If that doesn’t work, take white willow bark. This plant contains salicin, the same compound found in aspirin. Hippocrates had his patients chew on white willow bark to reduce inflammation. Studies show it relieves arthritis pain as well as lower back pain.4
  4. White willow bark won’t upset your stomach like aspirin might. You can find it in health food stores or online. I recommend 240 mg per day.
  5. And for arthritis, try ashwagandha. This “smart plant” is also called Indian ginseng and winter cherry. In a recent study, researchers gave 60 arthritis patients ashwagandha or a placebo. After 12 weeks, those taking the herb had significantly less pain according to three different pain-score tests.5
  6. I recommend 300 mg to 500 mg twice a day. Or you can buy dried ashwagandha root powder. Look for a product that’s 100% organic with no artificial flavors or colors. I like to add one teaspoon to a cup of boiling organic milk. I let it simmer for five minutes. Then I add a little honey to taste.

Aim to get at least 600 mg of DHA and 400 mg of its cousin EPA every day. And make sure you take them with meals so these omega-3 fats can be digested properly.

Al Sears, MD

  1. Franceschi F, et al. “A novel lecithin based delivery form of Boswellic acids (Casperome®) for the management of osteo-muscular pain: A registry study in young rugby players.” Eur Rev Med Pharmacol Sci. 2016; 20(19): 4156-4161.
  2. Chopra A, et al. “Ayurvedic medicine offers a good alternative to glucosamine and celecoxib in the treatment of symptomatic knee osteoarthritis: A randomized, double-blind, controlled equivalence drug trial.” Rheumatology (Oxford). 2013;52(8):1408-1417.
  3. Cohen MM. “Tulsi – Ocimum sanctum: A herb for all reasons.” J Ayurveda Integr Med. 2014; 5(4): 251–259.
  4. Chrubasik S, et al. “Treatment of low back pain exacerbations with willow bark extract: A randomized double-blind study.” Am J Med. 2000;109:(1): 9-14.
  5. Chopra A, et al. “Ayurveda–modern medicine interface: A critical appraisal of studies of Ayurvedic medicines to treat osteoarthritis and rheumatoid arthritis.” J Ayurveda Integr Med. 2010;1(3):190–198.

The Hacking of the American Mind—Report #4

Killing Jiminy: Stress, Fear, and Cortisol

For those of you that have been following our bi-monthly E-letter, Northwest Senior News, you may remember our series of reviews and digests from Dr. Stephen Sinatra’s book, The Great Cholesterol Myth. Sinatra listed the four leading causes of heart disease. Here they are.

  • Sugar
  • Inflammation
  • Oxidation
  • Stress

In Chapter 4, Dr. Lustig also references a connection between stress and sugar. Cortisol also gets thrown into the mix. What we can learn from various experts in their respective fields is that their messages, while slightly different and approaching issues from somewhat different vantage points, end up saying some very similar things. Sinatra focused on the myth of the cholesterol problem. Lustig has focused the problem of sugar addiction.

We recently did a serialized transcription of Gary Taubes’ YouTube video, The Case Against Sugar. Taubes’ focus is that sugar consumption leads to insulin resistance. His central theme is that hypertension, heart disease, diabetes, strokes, obesity, etc. are all a subset of insulin resistance. Again, we see these similar themes of hypertension, stroke, and obesity.

Lustig examines the interrelationship between pleasure and happiness and what happens when there is too much pleasure (addiction) and not enough happiness (depression). He very astutely zeros in on what are the drivers of sugar addiction. That is exactly what he does in Chapter 4, Killing Jiminy: Stress, Fear and Cortisol.

The big pictures of these authors (and certainly many others) is how to stay as healthy as possible. And that, of, course, is one of the reasons why we produce Northwest Senior News.

Background: For those that remember Pinocchio, Jiminy Cricket was Pinocchio’s conscience, reminding him of good and bad. Lustig says that the chemical changes that occur when a person is under chronic stress can contribute to a reduction of a person’s constraining forces not to do bad things (Ed: or even evil things).

Our review and digest of Chapter 4 begins.

Lusting tells us that stress is a normal part of life. If there is an immediate threat to our personal safety such as a lion in our path, our blood sugar and blood pressure will rise to prepare us for action. This stress (or fear) causes the release of a necessary hormone called cortisol from the adrenals, which are located on top of our kidneys.

Acute, short term cortisol release is both necessary for survival and is actually good for you. It increases vigilance, improves memory and immune function, and redirects blood flow to fuel the muscles, heart and brain. Your body is designed for cortisol to be released in any given stressful situation, but in small doses in short bursts.

Lustig suggests that modern conveniences such as electricity, air conditioning, and plenty of food have decreased stress in our lives. However, chronic stresses have “gone through the roof.” He says that these chronic stresses are taking a toll on people’s lives.

Chronic stress leads to constant cortisol releases which will slowly kill a person.

Evidence of the association of job stress, psychological distress, and disease is extremely compelling. Psychological stress in adolescence is directly linked to the risk of heart attack and diabetes in adulthood. Chronic stress also directly impacts the reward pathway as described in Chapter 3, and it has been shown that chronic stress can speed the onset of dementia.

My comments: We have a family acquaintance that worked on the staff of a leading orthopedic clinic in North Central Idaho for nine months. She had to quit her job because working for the doctors was too stressful. How many people have to endure stressful jobs because they can’t afford to quit?

Continuing: Lustig reminds us that people in lower socioeconomic or minority groups often have more stress, and because of that they suffer from higher rates of morbidity (sickness).

Stress breeds more cortisol.

. . . the more stress, the more breakdown of the endocannabinoid CBI receptor agonist and anti-anxiety compound anandamide, and the more anxiety.

Lustig references the connection with marijuana and states that its use can help a person “mellow out.” He also cautions that long term marijuana use can lead to a cognitive decline to the tune of eight IQ points. At that point, Lustig quips that those people may be less stressed about reality anyway.

My Comments: Cognitive decline all by itself is a potential aging issue. Why would anyone want to engage in a behavior that could hasten his/her mental decline? If there is a medical reason for using marijuana, that’s one thing. As far as keeping your mental faculties sharp, using pot recreationally doesn’t seem like a very smart idea.

A Bucket of Nerves

Continuing: Lustig explains that your body’s reaction to stress is the result of a cascade of responses.  The amygdala is the part of your brain that regulates this. When you encounter a threat such as a vicious dog or being contacted by nasty creditors, the amygdala activates the sympathetic nervous system. This raises your blood sugar and blood pressure to prepare you for the acute stress. The hypothalamus is the part of the brain that controls hormones. That tells the pituitary gland to tell the adrenal glands to release cortisol.

Occasional releases of cortisol are one thing, but continued exposure over the long term can exact a toll on your arteries and your heart, leading to hypertension and stroke. When everything is working well, you remember what caused a particular stress. For example, if you got freaked out by a snarling pit bull on a street you’re walking on, you’ll remember that and not walk down that street again if you can possibly help it.

Lusting explains that the hippocampus might be the most vulnerable part of the brain to cell death.

Almost any brain insult you can imagine (low blood glucose, energy deprivation or starvation, radiation) can knock off the neurons of the hippocampus. And one of the serial killers that attacks the neurons of the hippocampus is cortisol. The longer your cortisol stays elevated, the smaller and more vulnerable your hippocampus gets, which puts you at the risk for depression.

Lustig tells us that this is the likely reason why chronic stress leads to memory loss. Put more bluntly, he posits that chronic stress literally fries your brain, and it gets worse.

He continues by explaining that chronic stress impairs your ability to reason. The prefrontal cortex (PFC) is your high order or executive function part of your brain. Lustig uses the Jiminy Cricket analogy. Put another way, this is what tells us the difference between right and wrong and keeps us from going off the deep end, or what keeps us from indulging in bad behavior and keeps our baser desires in check.

A bad guy rapes Bill Smith’s daughter, and Bill finds out who the perp is. Bill is so angry at what happened that he feels like going over and taking the guy out. However, his rational side of his brain kicks in and tells himself that 1) he has no right to commit murder and 2) if he gets caught, tried and convicted of pre-meditated murder, he goes to the pen for a long time. His Jiminy Cricket says, “Okay, that’s your thought, but stop right there and get it out of your mind. You don’t want to be as bad as the other guy.”

In an uncontrollable, stressful situation, the amygdala-HPA trio (hypothalamus-pituitary gland-adrenal glands) axis commands the release of neurotransmitters including dopamine (yep, that again). These flood the prefrontal cortex (PFC), silencing Jiminy, which disinhibit you from doing some wild and crazy things. When your PFC is under fire by cortisol, your rational decision-making ability is toast.

My Comments: In the past few years we have heard of some things that people have done that are absolutely crazy. The woman in San Diego loses some YouTube revenue, so she drives up to the Bay Area and shoots some YouTube employees. Joe Blokes gets fired from his Post Office job, so he returns with a gun and shoots his boss. As I read this section of the text, I thought of these and other similar situations. You wonder, did these people just lose it without being aware of the consequences of what they were doing?

Continuing: Lusting explains that the more cortisol the amygdala is exposed to, the less it is dampened down by . . . the law of mass action.

More cortisol means fewer cortisol receptors in the amygdala, and the more likely your amygdala will do the talking from here on. Chronic stress day by day weakens your inner Jiminy.

Increased stress can turn a small desire into a big dopamine drive, which can be quenched by either drugs or food, or both. This is how the pizza and beer scenario typifies the American food experience.

My comments: There is a move afoot to absolve people of responsibility for their actions. Some suggest that we should have sympathy for the murderer or rapist because he had a bad childhood. This is along the lines of “he Devil made him do it.” The flip side here is that everyone has issues in his/her life, and everyone has to deal with various stresses. Maybe we have some events that are adding more stress compared to 20, 30, or 40 years ago. The key questions are, “What are the stresses I face and how can I minimize their effect on me?

Continuing: Lustig continues by saying that stress-induced dopamine has the capacity to remodel the prefrontal cortex so that it doesn’t work as well as before. Poor Jiminy Cricket has been squashed like a bug.

These neurons (the ones that house the dopamine receptors) are fewer and farther between. . . You need even more to get less. By driving the stimulation of the amygdala and decreasing your cognitive control centers, stress and cortisol make it much more likely that you will succumb to temptations.

Lustig poses a rhetorical question. Do you take three deep breaths or eat three doughnuts? Now it gets even scarier.

When cognitive control is lost, the ability to inhibit the drive to seek pleasure is lost. Stress promotes faster addiction to drugs of abuse and is likely the reason why drug addicts find it difficult to quit. Chronic stress kills off neurons in the PFC . . .

He reminds us that the preferred drug of choice when dealing with stress is, yes, yes, it’s SUGAR. Gary Taubes in his YouTube video The Case Against Sugar says essentially the same thing. It’s cheap, socially acceptable, and doesn’t appear to have immediate consequences. This sets up a vicious circle.

With chronic stress, eating is the preferred coping behavior of the individual. The person seeks energy dense food, usually loaded with sugar, which may become addictive. Since cortisol is an appetite stimulant, the infusion of cortisol into a person rapidly increases his/her food intake.

It gets even worse. Cortisol actually kills neurons that help inhibit food intake. Now a person eats even more food, usually sugar. The cycle continues.

If Only I Could Sleep at the Switch

Lustig tells us that another outcome of stress is reduced sleep. Reduced sleep also contributes to obesity. Short sleepers generally have an increased body moss index (BMI). Those deprived of sleep may consume up to 300 additional calories per day. The vicious circle gets worse and worse.

Dopamine makes you more likely to eat. The more you eat, the more likely you are to become obese. Obesity leads to sleep deprivation.

Lustig finishes the chapter by explaining that the impact of stress on children is even worse compared to adults. He says that this stress can lead to unhealthy snacking during adolescence. The result of that is overweight teens.

Lustig closes the chapter with:

The more chocolate cake you eat in response to stress, the less pleasure you will get and the sicker you will start to feel, which will drive even more stress. Those dopamine receptors need more but deliver less. You’ll become more tolerant or worse yet, addicted.

End

Why Your Pharmacist Can’t Tell You That a $20 Prescription Could Cost Only $8

Why Your Pharmacist Can’t Tell You That a $20 Prescription Could Cost Only $8

WASHINGTON — As consumers face rapidly rising drug costs, states across the country are moving to block “gag clauses” that prohibit pharmacists from telling customers that they could save money by paying cash for prescription drugs rather than using their health insurance.

Many pharmacists have expressed frustration about such provisions in their contracts with the powerful companies that manage drug benefits for insurers and employers. The clauses force the pharmacists to remain silent as, for example, a consumer pays $125 under her insurance plan for an influenza drug that would have cost $100 if purchased with cash.

Much of the difference often goes to the drug benefit managers.

Federal and state officials say they share the pharmacists’ concerns, and they have started taking action. At least five states have adopted laws to make sure pharmacists can inform patients about less costly ways to obtain their medicines, and at least a dozen others are considering legislation to prohibit gag clauses, according to the National Conference of State Legislatures.

Senator Susan Collins, Republican of Maine, said that after meeting recently with a group of pharmacists in her state, she was “outraged” to learn about the gag orders.

Click here to continue reading on the New York Times Website.

10 Things to Know About Your New Medicare Card

10 Things to Know About Your New Medicare Card

Background: As dictated by 2015 legislation, the Social Security Administration (SSA) will begin the roll-out of new Medicare cards without the use of Social Security numbers. This is help prevent identity theft as Medicare has used Social Security numbers since its inception on your Medicare cards.

The following list is from Centers for Medicare and Medicaid services (CMS).

  1. Mailing takes time. Your card may arrive at a different time than your friend’s or neighbor’s.
  2. Destroy your old Medicare card: Once you get your new Medicare card, destroy you old Medicare card and start using your new card right away.
  3. Guard you card: Only give your new Medicare number to doctors, pharmacists, other health care providers, your insurers, or people you trust to work with Medicare on you behalf.

Our comments: For some reason the CMS in its publication avoids mentioning insurance agents. When filling out an application for a Medicare supplement, Medicare advantage, or a Part D Rx plan, we must put down your Medicare number on the application.

  1. Your Medicare number in unique: Your care has a new number instead of your Social Security number. This new number is unique to you.
  2. Your new card is paper: Paper cards are easier for many providers to use and copy, and they save taxpayers a lot of money. Plus, you can print your own replacement card if your need one.

Our comments: Some people laminate their card. Technically, that may be a no-no, but obviously people do it anyway. For sure, make a photocopy of your new Medicare card. You could carry the copy with you and keep your government issued one safely at home.

  1. Keep you new care with you: Carry your new card and show it to your health care providers when you need care.

Our comments: The same as number five. We have seen some old paper cards so worn that they were virtually unreadable. There’s the wisdom in making a copy.

  1. Your doctor knows it’s coming: Doctors, other health care providers and facilities will ask you for your new Medicare care when you need care.
  2. You can find your number: If you forget your new card, you, your doctor or other health care provider may be able to look up you Medicare number online.

Our comments: Again, carry a copy or even multiple copies. Keep one in your car or other backup location. Since there is no SS# on the card, it will be virtually useless to an identity thief.

  1. Keep you Medicare advantage card: If you’re in a Medicare advantage Plan (like an HMO or PPO, your Medicare advantage Plan ID card is you main card for Medicate—you should still keep and use it whenever you need care. However, you also may be asked to show your new Medicare card, so you should carry this card, too.

Our comments: Back in 2006 when Medicare advantage plans ramped up, the companies were insistent that you SS numbers NOT be used on their ID cards.

  1. Help is available: If you don’t get your new Medicare card by April 2019, call 1-800-Medicare (1-800-633-4227). TTY users can call 1-877-486-2078. End of the CMS document

Avoid the Scammers: We have reprinted some of the tips from Ron Iverson concerning scammers. They are as follows:

First, scammers are calling Medicare recipients, sometimes identifying themselves as Medicare or “government” officials and telling them that the new cards are coming out, but that they will have to send $30-50 to get the new cards.  That is bogus—there is no charge for the new cards—and CMS/Medicare does not call people—it only uses the U.S. Postal Service to communicate.

The second technique is for the scammer to say that he has a Medicare Advantage Prescription Drug Plan available, but then request personal Medicare information so that the new plan can be utilized.  This is also bogus.  Whatever you do, do not fall for this.  Medicare information is personal, and the scammers simply use it for other nefarious activities.

So, we don’t know when or how the scammers will spring into operation in your area, but if you receive one of these calls, just hang up and report the activity with a call to 1-800-Medicare (800-633-4227).  And…above all, do not feel pressured to respond to any of these calls—the scammers are well-trained in intimidation and persistency.  Don’t fall for it. End

Gary Taubes ‘The Case Against Sugar’ Part 4

Gary Taubes ‘The Case Against Sugar’ Part 4

Transcription of Gary Taubes’ YouTube video, The Case Against Sugar, by Elizabeth Reedy

Key takeaways from Part 3

  • Sugar is like a drug that shows no immediate side effects.
  • Taubes made several references to the connection between consuming sugar and pleasure with this telling statement: . . . once the drug became identified with pleasure, how long before it would be used to celebrate birthdays, a soccer game, good grades in school?
  • As sugar became more available in Europe, it was added to all sorts of concoctions. Later in the U.S., sugar was added to the original Coca-Cola formula to mask the bitterness of cocaine and caffeine.

Begin at 49:31

The removal of cocaine in the first years of the 20th century seemed to have little influence on Coca-Cola’s ability to become, as one journalist described it later, “The sublimated essence of all that America stands for, the single most widely distributed product on the planet and the second most recognizable word on the earth, with okay being the first.”

It’s not a coincidence that John Pemberton, the inventor of Coca-Cola, had a morphine addiction that he’d acquired after being wounded in the Civil War. Coca-Cola is one of several patented medicines he invented to help wean him off of the harder drug. [Quoting Pemberton] “Like Coca, Kola enables its partakers to undergo long fast and fatigue,” read one article in 1884. “Two drugs, so closely related in their psychological properties cannot fail to command early universal attention.”

As for tobacco, sugar was and still is a critical ingredient in the American blended-tobacco cigarette, the first of which was Camel, introduced by R. J. Reynolds in 1913. It’s this “marriage of tobacco and sugar,” as a sugar-industry report described it in 1950, that makes for the “mild” experience of smoking cigarettes as compared with cigars and, perhaps more important, makes it possible for most of us to inhale cigarette smoke and draw it deep into our lungs.

It’s the “inhalibility” of American blended cigarettes that made them so powerfully addictive—as well as so potently carcinogenic—and that drove the explosion in cigarette smoking in the U.S.  and Europe in the first half of the 20th century, and the rest of the world shortly thereafter, and, of course, the lung-cancer epidemics that have accompanied it.

Here’s an interesting story. About fifteen years ago I read a book called Sugar Blues. Do any of you remember that? William Dufty, Gloria Swanson’s husband, wrote this book. In this book he talks about sugar and tobacco, and about how the sugar in the tobacco leaves is critical to the success of the American cigarette.

For years after that, I tried to confirm that story and I just couldn’t find any evidence to do it. Two things happened. The internet grew and grew, and more and more sources of evidence got scanned into the computer, and you could search through them.

I had gotten a grant from the Robert Wood Johnson Foundation to write this book on sugar, and part of the grant was to uncover what was the sugar industry’s influence on science in the 70s. I could feel it in the research that in the same way they discover planets by seeing the influence of another planet.

Also, back in 2011 I was lecturing at a bookstore in Denver. I had done nothing on the book, I had completely stalled. I had started my not-for-profit instead. After the lecture, this woman, Kristen Kerns, comes up to me and she says she’s a dentist there in Denver. She works in a lower-class clinic, and she deals with diabetics with terrible teeth all day long.

She read my book Good Calories, Bad Calories, and she became obsessed with it. Then she went to a lecture on dentistry and chronic disease, and she heard a speaker from the American Diabetes Association say that they didn’t know why diabetics had such poor teeth. Kristen was horrified, and she started investigating the sugar industry.

She used Google and she found a cache of sugar industry documents which were from a defunct sugar industry company that had gone out of business and donated its archives to Colorado State University. Then she drove up to Fort Collins, and she started looking through the boxes. She pulled out the first one and it was labeled “Confidential. Sugar industry documents.”

She tells me this story after my talk, and my eyes light up like the big bad wolf. It scared the hell out of me. I was like, “I want everything you’ve got, put it in my book and take credit for it.” I learned that Kristen’s sense of humor was different than mine. Anyway, we ended up working together. We did a cover story for Mother Jones, which helped Kristen get a job at UCSF as a researcher.

If you read the New York Times, you’ll see she has a couple of front-page stories based on her research. I also talk about her research in the book, and I’m proud to have played a role in her life, though I still regret having scared her so much that first day.

One of the documents that Kristen found is this document written by a sugar industry executive in 1954 called “The Marriage of Sugar and Tobacco.” So, after World War II, the sugar industry and all of America starts going on a diet, in part because artificial sweeteners become readily available and allowed people to cut calories. People were arguing that sugar is fattening.

The sugar industry sees the writing on the wall even then, and they realize they have to start diversifying their products. They have to find other products that they could be using, and they are proud of the fact that, in 1954, sugar has played such a major role in the tobacco industry. They’re bragging about it in this document, and they had no reason to think that it wasn’t a great thing. It was more American capitalism at work.

And so, it’s all laid out in this document, including the references to FDA reports and the names of tobacco company executives who could confirm it. This didn’t really fit into my book because my book is about heart disease and diabetes, not the role of sugar and tobacco. But how could I leave it out?

At one point I had a chapter called The Marriage of Sugar and Tobacco, and I’d given it the number two and a half. Have any of you seen the movie Being John Malkovich? There was a… Well, this chapter ended up being Chapter 3. My editor doesn’t have the same sense of humor I do, either.

The other interesting thing is that this had actually been covered by a brilliant historian of science at Stanford, Robert Proctor, who had written a 700-page exposé of the sugar industry called Golden Holocaust that is relentlessly reported.

He wrote it based on the tobacco industry documents, and he came upon this article in the tobacco industry documents. So it doesn’t really fit into his book, but he wrote about it anyway, probably because it’s such an amazing story about the role of sugar and tobacco.

I was still able to get the scoop in this book, first of all because Robert Proctor’s book is 700 pages long, and it’s hard to get through. I find myself talking about other people’s books, other people’s set of good calories and bad calories. It’s good but it’s long. Anyway, a little more reading and then we’ll go to Q & A’s.

Unlike alcohol, which was the only commonly available psychoactive substance in the Old World until sugar, nicotine and caffeine arrived on the scene. The latter three had at least some stimulating properties and so offered a very different experience, one that was more conductive to the labor of everyday life.

These were the “eighteenth-century equivalent of uppers,” writes the Scottish historian Niall Ferguson. “Taken together, the new drugs gave English society an almighty hit. The Empire, it might be said, was built on a huge sugar, caffeine and nicotine rush—a rush nearly everyone could experience.”

Sugar, more than anything, seems to have made life worth living (as it still does) for so many, particularly those whose lives were absent from the kind of pleasures that relative wealth and daily hours of leisure might otherwise provide.

As early as the twelfth century, one contemporary chronicler of the Crusades, Albert of Aachen, was describing merely the opportunity to sample the sugar from the cane that the Crusaders found growing in the fields of what are now Israel and Lebanon as in and of itself “some compensation for the sufferings they had endured.” “The pilgrims,” he wrote, “could not get enough of its sweetness.”

As sugar, tea, and coffee instigated the transformation of daily life in Europe and the Americas in the seventeenth and eighteenth centuries, they became the indulgence that the laboring classes could afford; by the 1870s, they had come to be considered necessities of life.

During periods of economic hardship, as the British physician and researcher Edward Smith observed at the time, the British poor would sacrifice the nutritious items of their diet before they’d cut back on the sugar they consumed.

In nutritional terms,” suggested three British researchers in 1970 in an analysis of the results of Smith’s survey, “it would have been better if some of the money spent on sugar had been diverted to buy bread and potatoes, since this would have given them very many more calories for the same money, as well as providing some protein, vitamins and minerals, which sugar lacks entirely.

In fact, however, we find that a taste for the sweetness of sugar tends to become fixed. The choice to eat almost as much sugar as they used to do, while substantially reducing the amount of meat, reinforces our belief that people develop a liking for sugar that becomes difficult to resist or overcome.”

Sugar was “an ideal substance,” says Mintz. “It served to make a busy life seem less so; in the pause it refreshes, it eased the changes back and forth from work to rest; it provided swifter sensations of fullness or satisfaction than complex carbohydrates did; it combined easily with many other foods, in some of which it was also used (tea and biscuit, coffee and bun, chocolate and jam-smeared bread)…. No wonder the rich and powerful liked it so much, and no wonder the poor learned to love it.”

What Oscar Wilde wrote about cigarettes in 1891, when that indulgence was about to explode in popularity and availability, might also be said about sugar: It is “the perfect pleasure. It is exquisite, and it leaves one unsatisfied. What more can one want?

Thank you. I think I’ll leave it at that. Thank you.

Q&A: One man from the audience asks if we would be healthier or less healthy by using artificial sweeteners instead of sugar. Taubes’ response is that the science is inconclusive. He cited studies where the researchers use lean college students as guinea pigs to see how artificial sweeteners affects them. He says that those results may have different outcomes for middle-aged people, and especially those with medical issues.

My Comments: I was intrigued by Taubes’ comments about the use of sugar along with nicotine and caffeine as the “uppers” of the 17th-18th centuries in Europe and America. They helped to give people a lift from the drudgeries of a hard life. I wonder if things aren’t all that much different in the 21st century.

Rebecca, for example, looks forward to her morning and afternoon coffee breaks at her office. That’s time to get a cup of sweetened coffee and a Danish or some other pastry that a colleague brought to their office. End

The Hacking of the American Mind—Report #3

The Hacking of the American Mind—Report Number 3

by Robert H Lustig, MD, MSL

Synopsis of Report #2

Two quotes from Lustig well sums up his account so far.

No pleasure means no happiness. Pleasure is the straw that stirs the drink. Happiness is the drink. Anxiety melts the ice cubes. We all need reward, because reward keep anxiety at bay . . . for a short time.

When taken to the extreme, these two pathways can take you to the highest mountain or the lowest valley—addiction, depression, and just plain misery. The science in Part 2 and 3 says so.

Pleasure and happiness are interrelated, and there has to be a proper balance. If all pleasure is removed from a person’s living, his/her zest for life is gone.

Chapter 3: Desire and Dopamine, Pleasure and Opioids

Lustig is a university trained medical doctor. He’s also an endocrinologist, and his writing is on a university level with almost the expectation that his reader can grasp the technical terminology that he uses. As I mentioned before, understanding some of his technical stuff is stretching my brain. I will do my best to interpret it for you.

Lustig starts out by reminding us that reward is a strong driver of human emotion. He uses several paragraphs to explain this in greater detail. His summation is as follows:

Reward is first and foremost. Reward is the end. And sometimes reward literally becomes your end. Because one reward is never enough. When one reward becomes the primary goal, overwhelming all else, the end consequence is addiction—perhaps the nadir (the lowest point) of unhappiness. Therefore, understanding the inner working of reward is paramount to any discussion of personal or societal benefit or detriment.

My Comments: Lustig is spot on when he says, “becomes your end.” I have two cousins that predeceased their parents due to booze and drugs. Their reward was their end.

I have witnessed several people so addicted to their refined carbohydrates that they are dying a slow death of degenerative diseases, meaning obesity, diabetes, heart attacks and strokes. They’re still consuming their sweets, and gradually losing the battle with ever increasing doses of insulin. It’s akin to the person with emphysema that continues to smoke.

Continuing: Lustig says that the reward pathway is basic to survival. If our parents hadn’t enjoyed sex, we might not have been reading this text. He says that scientists have now learned how the reward pathways work and how they can be manipulated for both good and bad.

From hereon out, the chapter gets very technical. Please feel free to read it in its entirety if you care to delve into the intricate details.

Lustig says that we can distill the discussion down to the trigger of the pathway: dopamine:

…Virtually all pleasurable activities (sex, drugs, alcohol, food, gambling, shopping, the internet) employ the dopamine pathway in the brain to generate the motivation. But too much dopamine starts the downward spiral toward misery (my emphasis). If you can put “-aholic” on the end of the word (alcoholic, shopaholic, chocaholic, sexaholic) then the dopamine pathway is in play.

My Comments: I emphasized “misery” in that Lustig is so right with his analysis of too much dopamine. When he mentioned food, he didn’t elaborate, but you can bet your last dollar that he is referring to refined carbohydrates, meaning white flour and rice, sugars, and high fructose corn syrup, etc. I have a relative that is miserable because her choices of consuming alcohol and junk food have led her to type 2 diabetes, obesity, amputated toes, having a stroke, and now being confined to a wheelchair. All of this is for a person in her fifties!

Continuing: Lusting explains that our dopamine levels can be graded on a bell-shaped curve.  If a person doesn’t have enough dopamine, she will be lethargic and have little motivation for reward.

But if you’re already at the top of your bell-shaped curve, and you get that same dopamine boast, it can result in a transitional state that can quite unpleasant. Moreover, your current position on that bell-shaped curve can be changed by your experience with many forces, including stress and medicines.

Lustig cites two examples of being moved the wrong way on this bell curve. Number one is obesity. In a nutshell, obesity plays havoc with your dopamine system in very consistent ways. The obese person is already skewed to the right on the bell-shaped curve. An advertisement for Oreos, for example, can trigger a dopamine release, and now the person is overloaded with dopamine and has nowhere to go but down.

Worse, leptin is the hormone that tells our brains that we have had enough. It can get totally fouled up in the obese person’s brain* resulting in eating the second, third, and fourth pint of ice cream. The dopamine satisfaction continues to dwindle so he gets less and less reward from eating the ice cream. *Rather than referring the anatomical terminology for various parts of our brains, I’ll keep it simple and only use the word “brain.”

For a deeper understanding of how leptin works, Lustig references his book Fat Chance: Beating the odds against Sugar, Processed Food, and Disease. He also explains that some people have a genetic disposition for their obesity. Part of their brain can light up faster and quicker when they see a food commercial compared to people with normal weight.

My Comment: Lustig brings up the subject of food commercials. Where do you see most of these commercials? Of course, it’s on television. Please permit me to explain the power of advertising and how it plays around with our minds.

Let’s say Wilma Nesmeyer is 30 years old and has never touched alcohol in her life. She has her first taste of wine, only a few ounces, and she is already in a swooning state from the effects of what little alcohol was in that wine. It had an extraordinarily powerful effect on her. Just a small dose sent her reeling.

I don’t watch television, and I don’t have a TV in my home as my time is too valuable to passively sit and watch the screen. I’d rather be doing something more productive.

However, when I visit my sister-in-law who lives out-of-state, I’m exposed to the TV and its advertising. She’s a widow and has it on all the time. I ask her to turn it down or even off when I’m interacting with her. However, sometimes I’m forced to watch some of it.

I’m like Wilma. I literally feel the effects of how the advertising is working on my mind. One or two doses of it sends me reeling. It’s like, “Wow, what hit me; what’s pulling at my brain?” It like an assault on my mind. I certainly don’t like allowing someone to subliminally screw around with my emotions. I used to love eating Oreos, and seeing an Oreos commercial wants to trigger my dopamine response. In another era, it could have been the motivation to buy some. It’s incredibly powerful!

If you are trying to overcome your addiction to sugary, refined and processed foods, exposing yourself to advertising is like trying to put out the fire while at the same time fueling the flames. If you know you have a weakness here (most of us do), it’s best to minimize our exposure to advertising as much as possible.

Continuing: The second example that Lustig cites is estrogen. Simply put, rising estrogen means rising dopamine. He gives examples of how this can affect a woman’s moods.  She can be either focused and motivated, checking things off her to-do-lists, or on the verge of maiming her family member for forgetting to pick up the ice cream. For complete details, please refer to pages 50-51.

Get a Hit, Get a Rush

Lustig explains that there are three separate modes for the regulations of our dopamine levels.

(1) Synthesis: Dopamine is made in neurons of the ventral tegmental area (VTA) from the amino acid tyrosine, found in many foods. Ed: Examples are high-protein foods such as chicken, turkey, fish, milk, yogurt, cottage cheese, cheese, peanuts, almonds, pumpkin seeds, sesame seeds, lima beans, and avocados.

Lustig continues with a brief discussion of drugs that have been used to either decrease or increase dopamine levels.

(2) Action: This gets very technical. There are receptors for the dopamine that is produced our brains. If a person has fewer receptors, in part due to genetic reasons, it takes more dopamine to arrive at one’s optimal level. If a person has fewer receptors, then it takes more food intake to generate the reward, and that, of course, leads to weight gain. Put another way, this person needs more of a fix to generate the same level of reward as people without this particular genetic variation.

Lustig describes some of the uses for pharmaceutical drugs such as Risperdal, Zyprexa, and Abilify. They are used to enhance the effects of a person’s anti-depressant prescription. These drugs may be also used to treat ADHD, but they have their own side effects. These can be lack of motivation, walking around in a personality daze, and induce insulin resistance in the liver which leads to weight gain.

(3) Clearance: Remember, the synapses are the connecters between our nerves. The dopamine is like the electricity (electrons) flowing through the wires. The dopamine needs to be cleared out of the synapse, which occurs from one of two mechanisms.

The dopamine molecules can be recycled and used again. The dopamine transporter (DAT) transports and sucks dopamine back into the nerve terminal, removing it from the synapse and readying it for the next stimulus.

Lustig points out that cocaine and methamphetamine, in essence, fool the DATs into keeping more dopamine in the system. Now you know why they’re called uppers.

Dopamine molecules can be deactivated. The very technical explanation is on page 55.

Too Much of a Good Thing

Lustig cuts to the chase:

Recreational drugs such as cocaine are the quickest way to boost your dopamine. But drugs aren’t the only way to access reward, and drug use isn’t the only manifestation of a disordered reward pathway.

He explains that other behaviors can quickly can become addictive and specifically cites gambling. He mentions the excitement of the Kentucky Derby.

It generates the same dopamine rush, to different extents, as a ski run down a steep slope, a shopping spree . . . or a line of cocaine.

Lustig explains that dopamine is the just the gateway neurotransmitter or the trigger. He likens dopamine to sexual foreplay.

. . . the euphoria, the pleasure is mediated through another set of chemicals, the endogenous opioid peptides (EOPs) whose cell bodies are in the hypothalamus, the brain area that controls emotions. The most famous of these is beta-endorphin, the brain peptide with properties similar to morphine. It binds to the same opioid receptor as does morphine or heroin, generating the pleasure signal in the nucleus accumbens.

He explains that you can get there through the use of opioid drugs such as hydrocodone or OxyContin. Another way to get there is through your own beta-endorphin by vigorous exercise. This is known as the runner’s high.

There’s a problem here, just as there is with the over use of dopamine.

. . . [T]hose EOP receptors are also down-regulated with chronic exposure . . . although we’re not sure what happens to runners. . . . and when the opioid receptors down regulate, you go from wanting to needing. That’s the neuro-chemical equivalent of addiction.

If You Scratch You’ll Keep Itching

Lusting concludes this chapter by saying that the goal of reward is not in the motivation but rather it’s in the consummation. He says that activating these opioid receptors is where the action is.

Pleasure is the goal. Desire is the driver. Motivation drives the outward behavior, consummation is the inward expression of reward.

He recounts an incident when holed up in an old hot, muggy hotel in Paris when he had an itch for ice cream, and he satisfied that itch.

Reward comes in two phases. Motivation or desire triggers the dopamine. Consummation or pleasure comes from the endogenous opioid peptides (EOPs) delivered from parts of our brains.

Dopamine is the trigger and the EOPs are the bullets. You need both to fire the gun, unless someone fires the gun for you, like taking Demerol in the emergency room . .  . EOPs are designed to shut down further dopamine production.

If there is chronic over-stimulation, there is a reduction of dopamine receptors in the key area in our brains. This leads to needing more and more dopamine to get less and less of an effect. Lustig closes the chapter by saying that chronic stress impacts our dopamine more than anything else.

My Comments: Everything that Lustig has described in this chapter is how we are wired. It’s the human condition. What he hasn’t discussed, at least not yet, is how we can overcome this condition and not be controlled and driven by it. I’ll delve into this in the future. End.