Another cannabis update!

Greetings, good people of Oregon! I spent today at a continuing education course with Dr. Michael Howard, a 50 year veteran of treating addiction and psychiatric disease. The first part of the class was about opiate abuse, and the current state of the opiate epidemic. The second part, which I will explore in this blog, focused on our current knowledge of cannabis.

I wrote my cannabis position statement last year based on my observations after three years of legalization. My position hasn’t changed… much… in response to this course. It has changed a little, and I will explain. First, because people love bullet points, here are my key takeaways.

  1. Research confirms cannabis is not a gateway drug. In fact, nicotine is far, far more likely to lead to abuse of other substances than cannabis.

  2. Research confirms low rates of addiction with cannabis. BUT low does not mean impossible, and the 1-2% of adult onset users who do become addicted display all the common traits of addicts to other drugs like heroin and meth as far as loss of function, crime, damage to social standing, etc. Rates of addiction for people who start using in adolescence are higher, at about 4%, which is concerning.

  3. Use of cannabis that begins in adolescence is by far the most concerning use of cannabis. The presenter was not concrete as far as how “adolescence” is defined, or what “heavy use” means. However, my impression is that you don’t want teens younger than about 17 using regularly, because of the evidence for long term brain changes and increased risk of addiction.

  4. While there is currently little evidence of cannabis use causing disease, all sort of negative side effects can and do occur, such as anxiety, vomiting, loss of motivation, sleep disturbances, and paranoia. Dr. Howard suspects the reason there is little evidence for cannabis smoking causing lung disease is that, compared to cigarettes, people just don’t smoke that much cannabis. For example, the average cigarette user smokes 19 cigarettes per day; the average cannabis smoker consumes two joints per week.

  5. Edibles are the surest way of having a bad trip, and should be approached with the greatest caution.

As far as my personal position on cannabis, I have revised my earlier statement that the age of recreational use should be raised to 25 to thinking age 21 is just fine. That is well out of the zone where we might see long term damage and increased risk of addiction. Also, my main concern is for teens. The following are my points of advice for people who are active in the lives of kids aged 10-16.

  1. Remember that the years 10-16 are when initial contact with cannabis is both most likely to occur, and most likely to lead to long term damage and development of cannabis addiction.

  2. An adolescent is more likely to use cannabis if someone in the family uses cannabis. In my opinion, parents or parental figures who use cannabis should take pains to keep it well away from the adolescent, and strongly reinforce that cannabis is for adults. Adolescents are also more likely to use if a friend is a chronic user. Find out what your kid’s friends are up to.

  3. Treat regular cannabis use in adolescents seriously. There is evidence chronic use in adolescence reduces IQ 6 to 9 points, and that may not recover fully after use stops.

  4. Adolescents with a family history of addiction, abuse history, ADHD, or antisocial behavior are more likely to develop cannabis addiction than kids without those traits.

  5. HOWEVER, do not panic. Compared to drugs like nicotine, alcohol, meth, and opiates, cannabis remains pretty tame. While parents never want to see their kid be a regular drug user, your family will get through your child’s cannabis use. And it’s key to remember the problems come with regular use, not the occasional smoke with friends.

Large scale research remains hampered by the federal government insisting on keeping cannabis a Schedule I controlled substance. I didn’t know this, but federally-approved research can only be done on the strain available from the University of Mississippi! We need cannabis off the Schedule I list ASAP to get better science.

All things in moderation, dear neighbors.

Zzzzzz..... SLEEP!

Many of my patients complain about not sleeping well. Especially as we move into middle age, a truly restorative night’s sleep can become more of a treat than an expectation. People may find they have a harder time falling asleep, or may spend some time awake in the night. They can become distressed that they have insomnia, and this worry makes their sleep troubles worse.

In Chinese medicine, sleep troubles can come from different factors, primarily involving the Chinese Liver, Kidney, and Heart organs. Dysfunction in those organs, or a deficiency of qi or blood, can lead to poor sleep. In evaluating sleep patients, we have to distinguish the factors that contribute the most, and treat them.

We have to be clear on what good sleep is. Many of us have the idea that falling right to sleep, and sleeping for eight unbroken hours is the standard for good sleep. That is a myth, and it creates anxiety about insomnia in people who don’t sleep that way. Historically, we see what’s referred to as “the second sleep.” It was very common in premodern times for people to go to sleep, wake for awhile in the night, and then go back to bed to finish sleeping. In the Catholic monastic tradition, there is even a service held at 2 a.m., Matins. I remember reading about a study where the scientists took modern people and put them in an environment without supplemental light, so people were dependent upon the sun. After several weeks, they had adopted a two sleep pattern.

According to an article I read, I regret I do not have a link, historically the second sleep was for quiet activity. People would do some reading, pray or meditate, write letters, or enjoy their partners without the interference of children. Yet many of my patients worry that the appearance of a two sleep pattern indicates sleep dysfunction. They feel dysfunctional because right when they fall back asleep, it seems the alarm goes off, and they have to get up and prepare for the day, under-rested and groggy.

This is the crux of the matter: the problem isn’t the second sleep, it’s the schedule. Premodern people, largely in charge of their own labors, were free to enjoy the second sleep. Modern people, wedged into somebody else’s schedule, have to be at work at a time chosen by someone else. They are not free to sleep late enough to complete the second sleep. The brain’s regeneration is interrupted, and the sleep is not restful. The problem is with the clock, not with the people.

In addition to those who worry about normal sleep, there are the people who just don’t go to bed. These are people from teens through middle age who don’t think they need to sleep, and think they are fine if they get 4 or 5 hours of sleep per night. They are not fine. You are not fine. This is not enough sleep. I know the TV show is compelling, I know you are hip deep in that project, I know you think the world will fall apart if you don’t get that done, but you are sacrificing your health. No, you can’t “make it up” by sleeping til noon on the weekends. It doesn’t work, and the unpredictability of the sleep schedule makes it hard for your body to establish a sleep rhythm.

A new paper in the journal Sleep Health outlines common sleep myths, how they are harmful, and some truths about sleep. I largely agree with this article. I take minor exception to their position on naps. (I am in favor of naps when a person’s work schedule does not allow them to meet their sleep needs overnight.) You can find the article HERE.

I do not deny there are genuine sleep problems. Disharmonies in the Chinese Liver, Heart, and Kidney certainly create sleep disturbances. Some people get their cortisol schedules backwards and feel groggy all day, but wide awake at night. These are real problems that deserve treatment. Chinese medicine has a lot to offer in terms of sleep treatment. But before you decide you have insomnia, reflect on whether you actually have a sleep problem or just a mismatch between your clock schedule and your natural sleep pattern.

Sweet dreams!

Update on cannabis psychosis (? ! ! ?)

When Oregon legalized cannabis for all users over the age of 21, we knew the plant had the potential to induce psychosis in some users. However, those reports were few, and many of us thought those cases were limited to people with prior history of psychosis, such as those with schizophrenia, or bipolar disorder with psychotic aspects. Since cannabis was so thoroughly prohibited previously, we weren’t able to do proper trials. With expanding legalization, epidemiological data is coming in.

A new study published in The Lancet Psychiatry reports an increase in cases of psychosis among heavy cannabis users, with a significant increase in risk when high potency strains are used and/ or heavy use begins in adolescence. Link to a summary from NPR with additional links HERE.

This news has not altered my position on cannabis. I continue to believe public health would be best served by establishing over the counter and prescription strengths of cannabis; releasing public money for the study of cannabis, and restricting recreational sales to people over age 25.

The cannabis enthusiasts continue to misrepresent the safety of the plant. It is not safe for all people at every level of consumption. Heavy cannabis use is linked to chronic vomiting, and now to psychosis. Educate yourself, your loved ones, be a knowledgeable consumer, and treat this powerful plant with great respect. Be safe, everyone.

2018, 2019, and the kata of medicine

Happy New Year! 2018 was another pleasant year for Peninsula Family Acupuncture, and that is thanks to the wonderful patients who support it over and over again. Your trust in me is a holy sacrament, and I remember it often. I know 2018 was difficult for a lot of people, but I was privileged to hold the eye of the storm, sheltered from the worst and able to provide a safe, if temporary harbor for the storm-battered. I hope PFA can continue to be regarded as a safe house; a place where people can bring their imperfect selves and find acceptance, some healing, and a way forward.

With the arrival of 2019, lots of my colleagues and friends are sharing their goals for the year, and their resolutions. As usual, I don’t have any resolutions that are new for this year, nor do I have any specific business or practice goals. My sole goal in starting PFA was to earn a decent living doing this work. I’ve achieved that goal, so the goal now is to sustain it.

Goal-setting is such a strong foundation of growth. Why don’t I set more goals for myself? It isn’t that I never have goals. They come to me spontaneously, often with their timelines attached. It seems foreign to me to sit down and contrive goals, attaching considered timelines to them. My life has just never been like that. I appreciate that goal-setting is an approach that works for others; I just find that goals and timelines contrived from my cognitive brain fail to capture my interest. Rather, the goals that arise from my heart, my spirit, come to me with such force I am compelled to move with near obsessive determination. The rest of the time, I practice my kata.

“Kata” is a Japanese word for the practice of a set of skills, such as scales on a musical instrument, or the pliés of ballet, or the prescribed movements of martial arts practice, from which the term originates. Katas are set practice forms designed to develop the skills of the practitioner, and keep them sharp. Even for the master, katas call us back to our foundations, and keep us from becoming complacent. In the practice of acupuncture, there is a form to each treatment. While every patient and every treatment is different, the underlying kata remains present. Patients often think treatment is solely for their benefit, but it is also an important opportunity for the provider to practice their kata, their skills. When I practice the kata of treatment, I develop, hone, and maintain myriad skills that propel me along the course of my life’s path. I am immensely grateful for this opportunity.

While I may be short on goals and resolutions for 2019, you can be certain that I remain dedicated to the kata that is my work, and to the patients who step into the treatment room to be my partners for that kata. May 2019 see us all learn more, develop more, and attain greater mastery over our selves.

Cannabis position statement

DISCLAIMER: This blog post is for informational purposes only, and should in no way be considered medical advice or cannabis promotion.

We are three years into the legalization of marijuana sales and consumption by Oregonians over the age of 21. A lot has changed since 2015, and watching everything unfold, I have formed my opinions. To summarize:

  1. I support the decriminalization of cannabis at the federal level.

  2. We need federal legalization to promote research into the usage and dosing of cannabis.

  3. We need over the counter and prescription categories of cannabis products.

  4. We need to raise the legal age of access to over the counter cannabis.

  5. We need better oversight and training of cannabis facilities and staff.

Decriminalization - Generally speaking, cannabis use by adults carries a low level of risk. Compared to alcohol, prescription drugs, and other recreational substances, cannabis is pretty tame. For most people, the biggest risk is driving while under the influence - the same risk we assume with alcohol and prescription drugs. Excessive consumption of cannabis has been linked to chronic vomiting, which goes away on stopping cannabis. People with pre-existing psychosis may suffer a psychotic crisis from cannabis. But for most adults, the risks are quite reasonable compared to other legal substances, so criminalization under the guise of protecting the public doesn’t make sense. Given the history of using the criminalization of cannabis as a way of promoting a racist agenda, federal decriminalization is the most reasonable and equitable approach.

The need for research - The inclusion of cannabis on the Schedule 1 list of controlled substances has prevented meaningful, large scale scientific research and trials. While I offer my respect to the cannabis pioneers who labored in unfunded labs, and I acknowledge the compelling anecdotes of the many medical and recreational users, they are not a substitute for the scientific teams that typically apply their skills and knowledge to the investigation of medicines. Removing cannabis from Schedule 1 is necessary to fully open the gates of meaningful research. Sadly, this will also produce the patenting of cannabis strains by big pharma, so we will likely see some forms of cannabis removed from public access. It is also possible pharma will move to have research restricted to pharma labs, effectively preventing product development by grassroots producers. This is an important political issue that will doubtless arise as cannabis moves forward, and cannabis advocates should take pains to see that grassroots access is maintained. But cannabis is a complex medicine. Our understanding at this point is mostly limited to THC and CBD, the two primary active compounds in cannabis. Much is made of the relative abundance of THC versus CBD in many cannabis products, but the accuracy of those statements by any given producer isn’t guaranteed. And we don’t have research to tell us whether it is the absolute dose of THC versus CBD that matters more, or whether the ratio matters more. We don’t know, for example, the optimal quantity, frequency, and duration of cannabis treatment for seizures in children, or anxiety in adults. For people seeking relief from serious medical conditions, there is almost no guidance other than the cannabis enthusiast staffing the dispensary - a person who likely has no medical training at all. As a healthcare provider, the situation makes me unhappy. Patients are thrown into what is essentially a free for all when it comes to procuring the proper strain of cannabis and dosing it appropriately. We need well-funded, experienced labs to help us fill in the gaps in our understanding of cannabis as medicine and long-term recreational substance.

Over the counter versus prescription - This is a very basic concept in medicine that has existed as long as the tradition of the physician/ priest/ medicine worker. Humans have always had “home remedies” for everyday problems, plus special remedies that were accessed through a medical specialist. This is why your mom could give you an aspirin, but not antibiotics. This is why you can buy a weak concentration of topical cortisone, but need a prescription to take it by mouth, or in a strong topical preparation. With the increasingly potent preparations of cannabis that are available to the average consumer, it is time to establish over the counter and prescription levels of potency. My concern as a healthcare provider is wide open access to all kinds of cannabis leaves the uninformed public vulnerable to a host of not very dangerous but nonetheless really unpleasant and possibly long lasting adverse effects. In the last three years, friends and patients have reported cannabis mishaps from unknowingly ingesting way too much THC. If excessive THC is ingested via edibles, the bad trip can last all day. The general public is not at all savvy about selecting and ingesting cannabis. Establishing over the counter and prescription strengths of cannabis products would add a layer of protection for the casual cannabis user, as well as the suffering patient attempting to get relief through self-medication. Who would control prescription access? Likely it would start with professionals who currently have prescribing privileges, primarily MDs. Doctor-run cannabis clinics could dispense prescriptions, just as they did before recreational legalization.

Raising the legal age - In the United States, the age of 21 is the fullest attainment of adulthood. Yet in terms of neurodevelopment, we know the human brain continues to develop significantly until the age of 25; and there is some evidence emerging that cannabis can have long-lasting impacts on brain development in young people. While we need more research, discouraging recreational cannabis use before the age of 25 would provide a layer of protection against lasting damage for chronic users. Of course, it would be naive to assume raising the legal age would completely prevent underage consumption. Young people have ways of getting substances they want to imbibe. It would be a discouragement, nonetheless.

Oversight and training of the industry - The cannabis industry in Oregon right now is a free for all. Oregon is still trying to grapple with regulating the industry, and resources are not abundant. The Oregon cannabis supply has been compromised by high levels of pesticides multiple times, and product recalled. There are no standards for cannabis staffers, production workers or retail help. A consumer who knows nothing about cannabis may be assisted by a highly knowledgeable cannabis enthusiast who has taken the time to educate themselves about its chemistry, applications, dosing, and local suppliers; or they may be helped by a stoner who just loves to get high, assumes everyone else just wants to get high, and can’t believe he gets paid to help people get high. The onus is on the consumer to know their own needs, and be able to distinguish skilled help from unskilled. Basic training, like we have for food handlers, alcohol servers, and drivers, would offer some protection to cannabis consumers.

I am a practical healthcare provider. In the end, what matters to me is patients have access to safe and effective medicines. I am also a concerned citizen. I want the uninformed public to be protected from harm. I also don’t want drug laws to be used to unfairly single out vulnerable populations for persecution, which is how they are used now.

To my patients: Feel free to talk to me about your cannabis use, especially if you are using regularly, or using it to treat a medical condition. It may be important to your care. I am very open about this topic, and don’t want you to feel like you have to keep it a secret.

This blog represents my official wish for sensible federal cannabis policy.

Opiate addiction, acupuncture, you, me, and us

We're on drugs. Nationwide, we're on a lot of drugs. Those drugs kill a bunch of us every year. Lately, the nation has been focused on one class of drugs: opiates.

Opiates are drugs that affect opiate receptors in our brains. They come in prescription and street varieties. They are commonly prescribed for the treatment of pain. Prescription opiates include morphine, OxyContin, Percocet, methadone, and everyone's favorite, Vicodin. Any prescription drug can become a street drug, and street drug opiates include the infamous heroin, the indiscriminate slayer of suffering people across race and class.

It's hard to have a fair conversation about our opiate epidemic without acknowledging institutionalized racism. The opioid crisis is all over the news now. Legislators are convening hearings. Policy makers are drafting response strategies. Aggrieved family members are holding press conferences, begging people in charge to do something. The front page of the New York Times today tells us we set a record for annual overdose deaths last year. For white Americans, the opioid crisis seems like a new threat. But for many communities, the ravages of opioid addiction are historic, and their pleas for help went unanswered by the white institutions that controlled access to treatment. So we have to acknowledge that the reason everyone suddenly cares about opioids is now young white kids are dying after being given prescriptions for dental work and sports injuries. So there's that. But this post isn't about racism in healthcare. It's about drugs. And you. And us.

How do we get hooked on opiates? The basic mechanics of addiction is that there is some way our brains don't feel good, we find a substance that makes our brains feel better, but we have to take more and more of that substance to get the same effect, mostly because of how our brains regulate neurotransmitter receptors. All pain happens in the brain: physical pain, emotional pain, all of it. (Recent research shows your brain responds similarly to physical and emotional pain.) Opiates, whether they come from substances we take, or our own opioid substances we make ourselves, relieve that pain. When we take high powered opioids like prescription pain-relievers or heroin, the pain relief can bring feelings of blissfulness that people yearn to experience again and again. So they take another pill. Then they can't get more pills legally, so they buy pills on the street. Then maybe the pills aren't enough, so they get some heroin. Then they die, because they took too many pills or too much heroin, and their breathing stopped. 

The story of prescription opioids is complex. It involves the misapplication and misattribution of a very small scientific study, combined with the considerable marketing power of big pharma and the pressure on physicians to prescribe drugs and move the patient along, rather than take the time to dive into the patient's complaint and refer for non-drug therapies that cost more to provide. Just like institutional racism, the origin story of the 21st century opioid epidemic isn't the focus of this post. 

My concern is now. What's happening to my neighbors right now, and what can I, and we, do about it? You may think you are not touched by addiction, but you are. Addiction is why your sketchy neighbor steals your stuff. It's why the houseless folks living in the park near you leave trash lying about. It's why you can't go to that dog park anymore because you saw some needles. It's why your acquaintance lied to you about their kid dying in a car crash, when really it was an overdose of heroin. It's why your child's teacher was fired. Or your coworker. 

Even in the face of a destructive epidemic, physicians continue to prescribe massive amounts of opiates; insurance companies continue to put up barriers to effective non-opiate pain treatments like acupuncture, chiropractic, and physical therapy. Congress would rather see your relative die from an overdose of prescription painkillers rather than permit investigation of non-lethal marijuana as a treatment for chronic pain. The state of Oregon simultaneously declared a medical emergency about opiates and cut access to non-opiate care for public health recipients. This mobilization in response to dead white kids remains primarily lip-service.

I do have some advice. First of all, if you are a person with a history of serious addiction, please make sure your physician and dentist know that, and ask them not to prescribe you opiates. As a healthcare provider, I find it infuriating when one of my patients has worked so hard to stay clean, and a thoughtless prescriber gives them a month's supply of Vicodin. It is far, far easier to not take a bunch of Vicodin if you don't have any, versus resisting taking it when you do. If you don't have a history of addiction, and your doctor wants to prescribe an opiate, tread carefully. Make sure the opiate is really necessary. There may be other classes of drugs that can cover your pain. Many people need opiates for pain after surgery, but often not for as long as the physician prescribes them. You can ask for your prescription to be fewer days, so you have to refill it instead of just having extras lying around. This is especially important if a loved one with addiction shares your living space. 

If you live with chronic pain, demand non-drug alternatives. Get a referral to physical therapy. Come for acupuncture. Acupuncture is great for pain relief. I work with pain patients every day. It's rare that it doesn't help at all. It's always worth a try. 

If you are struggling with opiate addiction, demand treatment. Just because you are taking them on prescription doesn't make it o.k. to leave you without care. Acupuncture can be helpful in easing the symptoms of withdrawal as you reduce your use of opiates. Many drug treatment centers include acupuncture as part of their programs for this reason. 

Be a compassionate neighbor. Remember that addiction isn't a moral failing; it's a medical condition that stems from the interplay of pharmacology, neurobiology, and psychology. The scope of the epidemic speaks to the vulnerability of our communities as well as the potency of these excessively prescribed drugs. We are in this together, and together we have to demand change. 



Why I don't talk a lot about wellness

The US wellness economy is estimated to generate over $200 billion annually. Wellness brands are heavily advertised in all media, wellness promoters have become celebrities, and celebrities have become wellness promoters. Many acupuncture practices have wellness in their names. Healthcare thinkers have been critical of US healthcare, calling it "sick care" when it should strive to be "well care." My colleagues point to the example of old China, in which the Emperor's physician was only paid when the Emperor was well, and was not paid if he fell ill.

According to US media representations, we should all be pursuing a lifestyle that promotes wellness. The trappings of that wellness lifestyle include things like yoga, juicing, spin class, kettlebells, oxygen therapies, high end skin care, a low carb diet, superfoods, and many, many more. Then of course you need the stuff that goes with that stuff, like the yoga clothes, the gym membership, the juicer, the free range meats, imported acai, etc. The implication from advertising is if you do all these things properly, you won't age, you won't get disease, and you'll be happy. The thinking is if a good diet is good, a great diet must be great. If some exercise is good, a lot must be great. If reducing chemical exposure is good, strict avoidance must be ideal.

So why aren't I on this bandwagon? I mean, I'm an acupuncturist. I should be all over the wellness thing. I should be raking in my slice of that $200 billion pie selling wellness. What gives? Don't I believe in wellness?

To a point, sure, I believe in wellness. But the media would have us blow well past that point into the realms of obsession, and I just don't see the research to support that as being so much more important than a meaningful life with fulfilling relationships. It isn't that I have a quarrel with the benefits of wellness practices. If you pick one and do it, you will probably feel better. My quarrel is that all of those practices, including coming to acupuncture, take time and money away from having a meaningful life with fulfilling relationships if your closest humans aren't doing them with you. 

The evidence suggests that for the average person in average health, the difference between taking an hour's walk a day, and doing gym workouts plus six classes a week, isn't that great as far as disease avoidance and mortality. The evidence suggests that a low carb diet is not superior to any other diet, including the much more moderate "Mediterranean diet" for promoting a healthy life. Yoga is not better than tai chi, and it isn't better than dancing, and it isn't better than walking your dog on forested trails. Eating an all-organic diet, while it has its own merits for benefits to the agricultural environment, has not been shown to be better for your health than non-organic foods. 

So where is wellness found? 25 years into my healthcare career, this is my current opinion. Eat real food. Be vegetarian or not, be low carb or not, it's up to you. But eat real food, ideally prepared at home. Don't go to restaurants too much. It isn't that restaurants are bad, but unless they are specifically health food restaurants, they will use way more sugar, salt, and fats than you would at home, so over time will bring you trouble. Your daily food should be simple, and ideally eaten with friends and loved ones. 

Get some exercise, again ideally with friends and loved ones. It doesn't really matter what it is. Whatever you can find time for and enjoy will work. Be sure to include some aerobic conditioning (brisk walking is fine) and a bit of strengthening. A few times a week is fine.

Go to sleep. You know who you are. You stay up too late. Just go to sleep. If you can't sleep, come see me. 

See if you can reduce stress. Some stressors are not in our control, but lots of them are, and we should take that control to make our lives better. See a counselor to get some ideas on how to reduce your stress; oftentimes we create stress within through mistaken notions of our self-worth, strengths, and responsibilities. Read some books or articles about stress. If you are parenting, think about reducing stress in your kid's life, too; they may need to do less.

You need to do less, too. That's the crux if why I don't talk a lot about wellness. If you use all your time doing wellness things that do not promote your own feelings of happiness and human connection, then that's less time you have for the things that do. For so many Americans, wellness activities have become the tasks we must do before we are allowed to engage in our happiness, like spending time with loved ones, engaging in hobbies, or just having down time. They become a stressor in their own right as we feel them looming over us, undone, when all we yearn for is hanging out with family. 

Of course there is a minimum of body maintenance we should all do. Of course we should stave off the slide into sickness and disability if we are able. But the ridiculous standards promoted in media take us away from the things masses of research say bring longevity, health, and happiness: love, purpose, and connection. 

My patients are always welcome to come in for a treatment. Acupuncture is fantastic, and is really good at helping us feel well. But if you don't have illness or injury, I don't want it to be another thing on your to do list. I want you to be out engaging in the pleasures of good company, play, expression, and nature. I'll be here when you need me. 

You don't need a "cleanse"

It's New Years, and you might be thinking about doing something nice for your body, the vehicle of your soul's expression that is so much more reliable than it ought to be, given how you treat it. Maybe you want to give it more exercise, or feed it better, or get more sleep, or more acupuncture! Those are all great ideas. But the wellness bloggers would have you believe that what you really need is a cleanse, or a detox. Something like Whole 30, or a juice cleanse, or a high-priced "detox" smoothie mix.

Your body, beautifully designed by nature to work in this world, comes with detoxification systems already built in. Your liver, kidneys, and skin are all capable of detoxifying on a regular basis. This process is continuous, whether you are "detoxing" or not, whether you are taking milk thistle or not, whether you are eating "clean" or not. It's just that sometimes we are taking in crap faster than our bodies can get it out, so we begin to feel unwell. To "detox," all you need to do is stop ingesting crap faster than you can get rid of it. That's how all those fancy cleanses work; they get you to stop eating and drinking crap for a little while, and lo and behold, you feel better.

You can "detox" any time you like. You're smart, you know what things you eat and drink are crap. Just lay off those things and eat real food and drink water for a few weeks and presto, you're cleansed. If you need more structure than that or want something more dramatic, I think Whole 30 is pretty good. Its staged approach, real food basis, abundance of recipes, and lack of anything to purchase make it the most appealing. There's no benefit to buying drink mixes or tablets or supplements that are marketed for "detox." If you have properly functioning organs, those will add nothing to your "stop eating crap" plan. 

An exception to "you don't need a cleanse" is people suffering from disease. There are medically sound approaches to serious detoxing that can be helpful, and should only be pursued under medical supervision by a licensed provider. But for the rest of us just feeling fat and sluggish from the season's overindulgences, it's a lot simpler. Just lay off the crap. Happy detoxing!

Chickens don't build skyscrapers: future anxiety and being human

Many of my patients have some degree of anxiety. Indeed, it is an anxious time in an anxious world. But some of us are prone to higher degrees of anxiety over the future. We may fear something bad will happen. We may fear we will fail at something important. We may fear letting other people down. The practice of mindfulness is recommended as a remedy for anxiety. Most anxiety exists in the future - it is a future fear emotion. Thus, practicing mindfulness, limiting your focus to this very moment and not allowing your mind to race into the future, effectively reduces future fear.

I was talking to a patient about his anxiety the other day, and he lamented that he couldn't be more like the animals, who seem never to suffer from future anxiety. I was struck by his comment because people are not animals. Why would we wish to be like animals?

It is true that my chickens do not give much thought to the future. They do appear to live primarily in the present moment. They eat when hungry, brood with the season, rest when they are tired, and flee when they are threatened. Even under threat, once the threat is gone, they return to normal fairly quickly. Narrowly escaping a hawk does not see them still cowering in fear even two days later. They appear to have an advantage in being able to let go their fears as threats pass. 

But chickens don't build skyscrapers. Chickens build nests in response to the arrival of nesting season. The nest is basic, easily put together by first selecting the right spot, shaping the existing materials with feet and beak, and then pulling some feathers from one's breast to make it soft and warm. The nest is intended to serve only one set of chicks. She will not use the nest again. She does not envision generations of chicks, many years in the future, using this nest that she is laboring to build. Nor do squirrels, for all their reputation as future planners, truly do much future visioning. Science has discovered that squirrels do not actually remember where they have buried anything. Rather, when they are looking for stored goodies, they randomly dig in places where it seems likely they might have put something a season or two before. 

Some animals do seem to possess longer vision. Termites and ants, for example, can build permanent colony structures that will last for generations, and are properly oriented to sun and earth to provide optimal conditions for habitation. One wonders, then, if ants and termites, like humans, are more prone to future anxiety because of this ability. Do the first ones to break ground on a new colony fret over whether they have the orientation just right? Do they fear their peers will die a horrible death if the colony collapses, making plain their ineptitude? Has anyone measured levels of cortisol in termites? 

People are capable of vast future vision. We envision the future not only for ourselves, but for our family, our friends, total strangers, and people who aren't even born yet. We design parks, thinking of the people who will use them for years to come. We do medical research, looking for cures because we can envision a future where people don't suffer from terrible diseases. We start foundations to remedy the ills of society because we want a future where all people have peace, sustenance, education, and justice. And we build skyscrapers, gleaming towers that must account for future weather, future populations, and the future of the materials with which they are made, long beyond the life of the builders. Our ancestors long ago built houses of worship to glorify God with materials that would far outlast themselves. Today we can still worship in them because someone years ago saw the future. 

My dear anxious friends, do not be too hard on yourselves. The thing that makes you anxious is also part of what makes you human. That ability to see the worst coming is also your great gift to lay foundations for future generations. 

My advice to the catastrophizers: indulge! Indulge that terrible fantasy! Most people who are anxious stop with, "Something bad might happen." That does not allow your anxiety to complete the cycle, and you stay stuck there. Instead, play it out. What bad thing could happen? Could a loved one die? Could you go bankrupt? Could you end up divorced? Or unemployed? What is the bad thing you see on the horizon? Now, what would you do?

What would you do?

This is a critical question. It allows you to reflect on your skills and support. The mistake we make when contemplating disaster is we assume we are completely ignorant, helpless, and alone. That is just not true. We are adults who have acquired tremendous knowledge of the world, many skills, and many social supports. We have people who love us, and social programs to help us. If your spouse died, you would go on. If you went bankrupt, you would go on. If you got divorced or lost your job, you would go on. You would endure, because you have already endured so much. You would take concrete steps to help yourself, because you already do that every single day. You are so much more competent and capable and loved and supported than your anxiety thinks you are. Take those thoughts to completion, so your heart can see that I am right.

To worry is human. To envision the future is human. To adapt, and to love, and persevere is human. God bless the beasts, but that is not our path. We have bigger things to make. 

Exercise and insanity - pain, masochism, and rhabdo

Grueling physical training used to be something only encountered in the military, and used as much for shaping the psyche as for shaping the body. In recent years, we have seen a rise in extremely demanding exercise regimens geared toward the general public. Workouts like CrossFit, P90X, and other high intensity training have become very popular. CrossFit, especially, brings with it a culture of "never too much" and working well beyond exhaustion. I've never understood the appeal of a workout that leaves you vomiting, but I thought it was just because I am not a big fan of hard work.

My instincts may be right. This article from the New York Times describes the rise of rhabdomyolysis among people participating in punishing workouts. Rhabdomyolysis, or "rhabdo" as it's known among healthcare workers and high intensity athletes, is a condition in which your muscle cells basically puke out their contents. It is a life-threatening condition, and people with rhabdo require a hospital stay to rescue their kidneys.

Is your workout really worth two kidneys?

"Pain is weakness leaving the body." This can be very true for proper physical training. The root principle of strength training is to push the muscles beyond what they can do. This causes microtrauma of the tissue, which stimulates it to build back stronger. Carefully exceeding your body's abilities is key to making gains. The important word is "carefully." When people are in a class or trainer situation and feel social or personal pressure to complete the workout no matter what, they put themselves at risk of blowing so far past the body's limit, they trigger rhabdo. 

It isn't the workouts themselves that worry me, it's the culture; the culture that says physical toughness is a critical skill, that destruction and pain are admirable pursuits, and that pacing, graduated efforts, and respecting one's limits are for the weak. What does this masochistic Darwinism say about us?

I oppose fundamentalism of any kind: religious or ideological. "All or nothing" is not an attitude that embraces diversity or is kind to a flawed humanity. Your body is made to follow the Middle Way: some food, some work, some play, some rest. Your body has safeguards for surviving extraordinary circumstances; they are not meant to be engaged on a regular, repeating basis. Your body sends you pain signals primarily as a warning that tissue damage is happening. If you feel a little pain, there's a little damage. If you feel a lot of pain, there is a lot. To exercise is to care for your body. Cherish the wonderful body that is carrying you through your life, respect its wisdom and honor its limits. 

Meditation is hard. You should do it, anyway.

Meditation is often lumped in with traditional Chinese medicine and other aspects of Asian culture. "Tai chi and meditation," or "yoga and meditation," or "exercise and meditation" are prescriptions we often see for the ailments of modern America. I am trained in meditation. I have practiced meditation. So why don't I push meditation for my patients, as many of my colleagues do?

I think meditation is hard. Most meditation techniques have as their goal the quieting of the mind and a ceasing of thought. Essentially, the goal is to have the mind and body be still together. The body is sitting quietly, and the mind is quietly not thinking. As someone with a very active mind, for me this is an effective form of torture. I have spent many hours trying, and failing, to reach any sort of zone with sitting meditation. I have slightly more success with walking meditation. Chanting in foreign tongues remains effortful for me, for the most part, so my mind is engaged with proper pronunciation and keeping up with the group. Failing over and over and over, the benefits of practice largely undetectable, left me unmotivated to continue practice.

Do we need such a narrow definition of meditation, though? We have mounds of research on the effects of meditation on both novices and skilled meditators. There is no denying the benefits. But are there options for those whose egos can't tolerate the parade of failure? I maintain the answer is yes. It is my assertion that the meditative state need not be limited to the thoughtless mind, but rather is represented by unity of mind and body. I think we can agree that multi-tasking and lack of mindfulness are problematic. Perhaps your body is doing one thing, such as preparing dinner, but your mind is doing something completely different, such as adding something to a mental shopping list. Bringing mind and body together for the single task of making dinner, and then later for the task of making the shopping list, is preferable for the cultivation of serenity. 

I have just described mindfulness, the practice of which is now a large industry in the western world. But mindfulness teachers encourage students to practice as much as possible, each action being mindful. It is a great spiritual practice, But how easy is it to sustain a perpetually mindful attitude? Not easy at all. More failure.

I've grown to appreciate making space in my life for meditative activities that come naturally to me; activities whose unforced outcome is unity of mind and body. I think most people have something like that in their lives, and it passes unrecognized, rather than as a necessary tool for restoration of mind and body. Some things that fit the description for me are weeding my garden. dancing, and the climbing gym. When I am weeding, I have a narrow focus. I am seeking and pulling some plants from other plants, persistently, and with great care. I am thinking no other thoughts. When I dance, I experience unity of body and music (if my game is really on), and there are no thoughts. At the climbing gym, any split of mind and body results in a fall, so the motivation to stay unified is high, even though safety gear makes the risk low. I have asked patients about such activities for them, and answers include cooking and baking, hiking, bike riding, making art or music, building something, housecleaning, and other activities. I believe these activities, things that one does naturally with unity of mind and body, qualify as meditative activity. Do you feel calm and focused during and for awhile after? You were probably meditating.

But what about the "quiet mind?" Don't you have to stop thought for it to be meditation? We know from functional magnetic resonance imaging (fMRI), that brains "in the zone" are different from brains working effortfully. Researchers expected that for people with a particular talent, more of their brains would be active during that activity compared to less talented controls. The opposite was found. Rather than recruiting more brain areas during the expression of talent, such as writing, or music, talented people in the zone recruited much smaller areas of their brains, and the rest of the brain was quiet. Think about that for a moment. The zone is exemplified by singular focus and lack of cognitive noise. Doesn't that sound like monks sitting quietly and thinking no thoughts? Doesn't that sound like a meditative brain? It does to me.

Since I began to recognize meditation as fundamentally a unity of mind and body, my pursuit and appreciation of such experiences is much more gratifying, and I am careful to make time for them so I can reap the benefits. Perhaps someday I will be a person who can sit still and have no thoughts. Age is carrying me that direction, I think. Until then, I will weed, and I will dance, and I will climb. What will you do?

Endangered species in Chinese herbal medicine

This article from Yahoo is making the rounds on the internet. Chinese officials seized a large amount of pangolin scales. Pangolins are severely threatened in China, but their scales are highly prized as a traditional medicine, therefore they are still subject to collection.

Called chuan shan jia in pinyin, pangolin scales are in the herbal category of blood invigorators. Also in that category are several powerful plant medicines that can substitute quite successfully for pangolin. In fact, the rich herbal traditions of the many regions of China means almost no medicinal is irreplaceable in its function. In light of the flexibility of the medicines, there is zero reason to continue to take pangolins for their scales. 

Animals aren't the only ones threatened by Chinese medicine. Some plants once numerous in the wild are now nearly extinct there, existing primarily in cultivation. American ginseng is threatened right here in the US. Modern American herbalism training typically includes instruction on morality in herbal medicine, and how to take plants responsibly and with concern for future generations. China must reckon with these issues now, or we risk the complete loss of some valuable plant allies. 

I have never used pangolin, rhino, or bear bile, and I never will. 

Happy holidays from Peninsula Family Acupuncture!

Greetings, neighbors! The ice and snow have been melted away by the rain, and the full swing of the holidays is upon us. Here at Peninsula Family Acupuncture, that usually means a flurry of appointment activity. People cancel because plans have changed, or something happens and they need an appointment urgently. People say they don't want to come in because they will have family visiting, and then they need to come in because they have family visiting. 

I am here to serve through the season. You can come when you're sick, you can come when you're stressed, you can come because you strained your back getting the tree. I'll sell you a gift certificate for that person who is impossible to buy for. You can bring your visiting grandma, and I'll see her, too. I'll be away from the office for a few days right at Christmas, but otherwise I am here my usual hours.

The darkest part of the year is a time of quietude in nature, and north-dwellers traditionally feast and celebrate to clear the gloom and bring back the sun. May you find peace and joy with your loved ones!


Online scheduling service change!

The online scheduler we've all happily used for a couple of years, Mediyak, is shutting down. I am very sad to lose this awesome service. However, the developer is letting it go to do other things. I have switched to Full Slate for online scheduling. Ultimately, it should offer the same functions and ease of use as Mediyak. However, all schedulers require some massaging to get them set up just right. Please use the system without hesitation. However, if Full Slate allows you to schedule something it shouldn't have allowed, I will contact you to change the appointment. Thanks for your patience!

Thoughts on the post-partum time

OK, this article made me mad. As if new moms aren't under enough pressure already, the subtext of this article suggests you should be ready to get back to your exercise program two weeks after popping out your kid.

Where to start with my objections?

1. The critical postpartum recovery time: Some traditional cultures, such as in China and Mexico, consider a new mother to be weakened for four to six weeks following birth. During this time, she mostly stays indoors, and receives nourishing foods, and her kin take care of her family, household, new baby, and her. The understanding is that the community is making an investment. Giving the new mother plenty of rest following birth will ensure she is well-prepared, mentally and physically, to care for her child. To abandon the new mother in her weakened state risks her health, and the health of the growing infant. In China, the womb is considered to be very vulnerable during this time as it is still open, and damaging influences, such as cold, can easily get in. The Chinese also understand that making and delivering a baby requires a huge expenditure of blood and energy, all of which comes from the mother. Failing to replenish this expense risks poor milk flow, psychological distress, and prolonged poor health. 

To suggest that running a few miles two weeks after delivering a baby is a worthy goal goes against this traditional wisdom, and places the mother (and by association, the child) at risk.

2. Sometimes athletes need to chill out. Seriously, y'all athletic types can get obsessive and treat your sport like a necessary drug, to the point where you ignore all that is sensible about your health. The gal profiled in this article tried to run a mere three days after having her child. That is absolute madness, in my opinion. She says she discovered it wasn't a good idea and listened to her body, but she probably thought she was hearing her body before she set out. My obsessive athletic patients often have this characteristic: unless the pain or fatigue is so bad they cannot move, it "isn't too bad" and they can do their sport. Anything worse than "not too bad" is "a severe emergency!" because they can't do their sport. There is a whole range of body sensations starting with mild discomfort or fatigue, through moderate pain that lets up on stopping an activity, to severe pain that prevents activity. Obsessive athletes can lose sight of these nuances and view their sport through an all or nothing lens. Suggesting to dedicated athletes that "if it feels o.k." they might resume training as soon as a couple weeks after having a baby is going to be perceived by some as a license to overdo it and cause injury. For the first four weeks, exercise should be pleasant strolls about the neighborhood, not three mile runs.

3. The pressures on expectant and new moms are out of control, and it makes me quite angry. Not only does medical science keep heaping upon expectant mothers that the health of their child is completely under the control of their choices even before conception, and thus any hiccup their child might have in development is squarely on them; not only do we now have competitive birthing, where new mothers feel shamed if they had to have a c-section or epidural; not only do we as a nation completely abandon new mothers socially and financially, leaving them alone with their infants in their own weakened state during a time when mother and baby should be lavished with care and attention; now we are heaping upon that pile a helping of guilt if the new mother doesn't feel ready to be a runner within a couple of weeks? "Well, the new mom in this article is back to running! I feel awful, but I should try. I'm sure I can do it." Yeah, and drop all the baby weight, and use only cloth diapers, and make all your own baby food, too. It is completely ridiculous. 

In my ideal world, every new mother would receive the four to six weeks of total care at home for herself, her infant, and her family that were traditional in China, and is still traditional in Mexico. I've heard so many stories from women who were left alone in the postpartum time. It can be very traumatizing, and can prolong recovery from the birth experience. The postpartum time is for resting, healing, and replenishing the huge expense of child creation. It isn't for putting on your running shoes and getting your mileage back up. 

"Do you do acupuncture for weight loss?"

I get asked this question a lot. Everyone by now is well aware of America's obesity epidemic. Many of us have been dismayed to see our formerly-trim silhouettes become rounder and rounder as time goes by. We hear from our doctors that "if you lose some weight," health concern A, B, or C will show improvement. 

It isn't so easy, though is it? We eat a little less. We exercise. We lose a pound or two of the thirty we should. Maybe we ramp it up with a serious diet and exercise program, and we lose ten or 15 pounds. Then family comes to visit, or it's the holidays, or we get sick and the program goes out the window and we gain ten pounds back. It's disheartening. So people come to my office with the knee pain, back pain, hormonal imbalances, creeping blood sugar or other complaints for which their physician has recommended weight loss, and they ask. "Do you do acupuncture for weight loss?"

It's a tricky question, more of a "yes and no." Some sources will lead you to believe that acupuncture causes weight loss. You can even find some studies to that effect. Some sources say there is a magical point that will suppress your appetite. Believe me, if there was, I would use it. So what does acupuncture have to offer people trying to lose weight?

First of all, let's discuss limitations. If you have a lot of weight to lose, and are eating a terrible diet with no exercise, acupuncture is not a magic bullet. Also, if you are of normal weight but aspire to a Hollywood-ready figure, you won't get much help from acupuncture. So let's talk about the bulk of people seeking help for weight loss: people who used to be thinner, but time got away and they got kind of fat. What can acupuncture do for those people? The simple answer is acupuncture can treat the underlying reasons for overweight. Let's talk about those.

1. Pain: People in pain aren't usually the biggest exercise fans. It may be that you aren't overeating so much as you are under-exercising due to pain. Acupuncture is well-documented in its ability to reduce pain. 

2. Mental health: Anxiety and depression can interfere with your ability to pursue a weight loss plan. Acupuncture can be a great aid to better mental health. 

3. Hormone imbalances: Thyroid, adrenals, pancreas and sex hormones can all contribute to weight gain. Acupuncture can be helpful for balancing hormones to make weight loss easier.

4. Stress: How does stress make you fat? Adrenals. When you are under stress, your cortisol levels go up. This causes your body to retain fat, and also gives you sugar cravings. Acupuncture is well-known for relieving stress.

5. Food cravings: If cravings for unhealthy foods derail your diet efforts, acupuncture can help take the edge off those.

6. Water retention: By the time you are obese, you may have not only fat but also water retention. Obesity can impair your circulation and make it difficult for your body to excrete excess fluid the way it needs to. Acupuncture can open the water passages to release excess fluid, depending on overall health and the presence of other conditions such as diabetes, lymphedema, or heart failure.

I hope this makes it clear that acupuncture alone dos not make a weight loss plan. Any weight loss plan needs components of dietary changes, regular exercise, and treatment of underlying conditions. Acupuncture is a great choice for those underlying conditions. The whole food conversation is too big for even its own blog post. Even whole books cannot contain the entire discussion on diet. I may attempt a shamefully abbreviated discussion on food in a future post. Meanwhile, if you would like to add acupuncture to your weight loss plan, come on in!

I'm teaching a seminar because I care about acupuncture

I love acupuncture, but I didn't use to. Years ago, early in my practice, I wasn't sure acupuncture worked. Sometimes I would think magic was happening, but often patients were just slowly improving, and I wondered if it was me or time that was making people better. I heard stories about amazing acupuncture feats, but I didn't think any were happening in my clinic. I started to feel disengaged from my practice.

Fortunately, I was saved by a chance encounter with Japanese acupuncture. While this certainly isn't the only effective style out there, it is the one that resonates with me and the one that I rely on. Learning Japanese acupuncture changed my life! All of a sudden, really cool things started happening in clinic. Patients got better. I could see they were better. And I've spent the last several years continuing my studies.

Discovering methods that work has renewed my passion for acupuncture. It has also highlighted for me how many myths about acupuncture are floating around in the Chinese medicine community - myths about point locations, what kind of stimulation you have to do, how to select points, and when to expect results. I started to see how these myths were holding us back. I began to envision a seminar for acupuncturists from all traditions that would delve into the mysteries of this amazing treatment modality.

"Skills for Effective Acupuncture" is the incarnation of that vision. It is designed for practitioners from all traditions who want to get better results from the treatments they are already doing. Watching the masters work, one can see unifying assumptions and techniques that make our teachers so effective. This lab class will provide an opportunity for participants to refine their point selection, needle technique, and patient evaluation skills to increase acupuncture efficacy. This is not a Japanese acupuncture class! Rather, we will work with what you already know. Demonstration and small group practice with feedback will allow you discover your personal needle mojo. Enrollment is limited so I can give everyone personal attention. Please join me to play with needles and rediscover magic!

For details and registration, click the Seminars tab. See you in class!

Did you get fat? I got fat. It's o.k.

Every year, media leads into the holiday season with a bunch of articles about weight. "Statistics show Americans gain an average of five pounds every holiday season. The problem? They never lose it." Or, "How to stay on your diet through the holidays!" How about this one? "Healthy versions of your holiday favorites!" 

Blech. I don't know about you, but I do not care about gaining a few pounds, did not plan to stay on my diet over the holidays, and have no interest in healthy versions of childhood favorites. My grandma's kolache calls for plenty of butter and sour cream, and my other grandma's pie, well... let's just say it's a good thing all the sugar is balanced by all the fat or your pancreas might just walk off the job in disgust. And I am totally fine with that.

See, I'm holistic in my approach to life. That doesn't mean I treat every ill with vitamins, or that I'm careful to meditate daily. (I should meditate daily, but just like you, my commitment flags.) I'm holistic in that the needs of my body do not trump the needs of my spirit or my heart in all situations. I'm holistic in the sense that I believe our pursuits require balance, Our physical activity needs quiet repose, our attention to work needs time and space for play, and our healthy food choices demand indulgence. If a happy life lies in the middle, which I think it does, then weeks of food penance should be rewarded with our season of feasting.

Did I get fat? Yes, I got fat. But I got fat on the kolache my grandmother made for every family gathering. I got fat on the pie that has now been in my family for generations. I got fat on the homemade and artisan-crafted sweet treats kind people thought to bring me. Yes, I got fat, but I got fat renewing the bonds of family and culture, letting down my self-denial for a few days to enjoy a slice of pie in front of the fire. I don't regret one bite.

Did you get fat? It's o.k. Now it is January, and we have to go back to work, and back to school, and we have to get our schedules back in order. We have to reestablish our discipline, and eat vegetables besides potatoes and yams, and go back to the gym. Do just a little more for a few weeks, and you will be back to your pre-holiday weight. But you will still be wrapped in the warm memories of the holiday season, and the strengthening of heart and soul that comes laden with a few extra calories. 


Now offering facial rejuvenation (with an introductory deal!

I hinted in an earlier post about something exciting following my return from Spain. I am pleased to offer acupuncture facial rejuvenation! I went to Spain in May to study with Takeshi Kitagawa of Japan, who pioneered his own style of acupuncture for facial rejuvenation. 

Acupuncture for facial rejuvenation is a great option for people who want to improve the appearance of their faces, but shy away from more extreme cosmetic procedures like surgeries and peels. The results are less dramatic than those procedures, so it is not a substitute. However, acupuncture may give you a reduction in the appearance of wrinkles, improved skin texture, and less sagging. See the "Facial rejuvenation" tab under "services" for more information.

I am seeking six people to participate in an introductory deal on facial rejuvenation. You will receive up to your first six treatments for a reduced price of $50 each. Some restrictions apply. Please contact me for more information!