Every month I am touched by the enthusiasm of you all, taking the reigns of a trip that started with now-Dr. Chris Ogilvie driving us down in a van to a clinic made of trailers with no water or power.  That we now have to turn away more students than we take is frustrating but tribute to how far the SCNM chapter of Naturopaths Without Borders has come.

Thank you all so much, especially the team of Kelly, Jacob, and Jack who picked the group up when it stumbled, to Lisa and Ana who took the trip to the next level and enabled the chapter Presidents' sanity, and to the many Naturopathic Physicians who have made this trip not only an ongoing project, but the monthly pride of SCNM: Drs. Geyer, Oskin, McAllister, Retz, Caravone, and anyone else who has made the last-minute scramble for supervising physicians (the bane of my medical school existence) a thing of the past!

I can't wait to join you again!

Although there are many ways to make yourself smarter, I’m going to ironically focus on the 20% here that are easiest to implement and yield 80% of the results.  This is an add-on to my previous blog, Above Average (http://drseanx.com/45803667).

Standard disclaimer: go to a doctor (ideally an ND in my professional opinion) for a full workup and don’t do anything below without consulting with your doctor.  If you are experiencing significant loss of function, you may also need to see a neurologist for evaluation.  The following is general information and not recommendations for you or any diagnosis.

Regardless of goals, people will the biggest bang for your buck by optimizing food.  I won’t go into too much depth here, but know that there are 2 main principles, so often distorted by “diets”:

1. More good stuff

2.  Less bad stuff

Most people do best in that order – it’s easier to make some small wins that make you feel better in order to propel you forward to remove things difficult to give up.  I don’t think anyone needs to stop ALL sugary foods or eat pounds of leaves, it’s a stepwise journey and as long as you’re getting closer to your goal, pat yourself on the back.

Foods I like for brains:

·        Things that grow in or walk on the ground, especially nuts, berries, vegetables, wild fresh fish, and some whole grains and fruits.

·        Lots of water – 1/3-1/2 in ounces, of the number of pounds you weigh.  So a 150lb person would drink 50-75oz of water.

·        Coffee in moderation – mixed evidence that coffee consumption correlates with decreased risk for Alzheimer’s (stronger evidence for >4cups/day, which can be otherwise detrimental), and caffeine is arguably the best-researched brain booster (speed and long-term memory).  Tidbit: optimal (best ratio between positive and negative effects) dosing for brain boosting is .3mg per kilogram of body weight per hour (a 150lb person would drink 1 cup of coffee over 6 hours) – I wish I could find the citation for where I read that J.  I’m not a regular consumer of caffeine, but this is how I dosed for my board exam preparation.  I don’t suggest coffee for worn-out people, people who don’t drink enough water, migraine sufferers (except to treat migraines) or kids (Haitian children universally drink coffee from about age 2), but it is an antioxidant, stimulates detoxification, and helps the bowels move J

Foods I don’t like for brains:

·        In general, processed/packaged foods

·        Sodas, sugary drinks (including undiluted fruit juices)

·        In general, a carb-heavy diet – basically goes with the above 2, but balance is best.  Don’t go crazy on grains just because they grow from the ground, and go with less grains if you have weight to lose.

Exercise: #2 area to focus in my opinion.  Exercise balances neurotransmitters in the brain, enhances mood regulation, increases insulin sensitivity, and has been shown to both enhance memory and stave off Alzheimer’s.  A combination of cardio and weights is best.  If you have not weight trained properly before, working with a reputable Personal Trainer is a great way to create a program, set goals, and learn proper exercises.  There are all kinds of hacks for gaining strength/endurance, gaining mass, or losing fat, but for brain boosting, we want to be doing SOMETHING, CONSISTENTLY rather than paralysis by analysis.  And if you DO want to hack your exercise, read The 4 Hour Body.  According to Dr. William Franklin, a friend and Personal Trainer:

For corrective exercise and for anyone who is just getting up off the couch after a long time, check NASM.org and the CHEK Institute. For conditioning in general I'd expand that search to the National Strength and Conditioning Association. All of these have "find professionals" engines on their sites.

OK, one cool hack: 20 minutes before eating, especially a carb-heavy meal, do brief high-intensity exercise. 

Fix health deficits: if you have Insomnia, Depression, Diabetes, Cardiovascular disease, or other ailments, these should be your focus first.  Increased inflammation in the body, imbalanced neurotransmitters, deficient circulation, infections, dysbiosis, and raging blood sugars all will fog your brain and are more important to correct first.  You will find that boosting your

But you haven’t been reading this to hear “eat right and exercise,” you want the juicy stuff.  Here we go:

1.      Determine your cognitive strengths and weaknesses.  Rate yourself in the following areas:

    a.      Memory

    b.      Focus/concentration

    c.      Processing/speed

    d.      Endurance

    e.      Creativity

    f.       Circulatory stimulation

2.      Examine your purposes – are you studying for a big exam, a set of small exams (can you see how Naturopathic Medical school has biased my own thoughts? J), athletic performance, getting on Jeopardy, musical creation, musical performance, etc?  Think about the above areas that you seek to enhance.

3.      Now let’s look at my favorites for each…

Memory – the main class are the “cholinergics,” in this case supplements which increase levels or function of Acetylcholine in the brain.  Cholines are an easy start.  In increasing order of efficacy and expense:

Lecithin => Choline (bitartrate, citrate) => CDP-Choline => DMAE => alpha-glycerophosphoryl choline (α-GPC) => Centrophenoxine

Side nutrients to help with Acetylcholine function include Acetyl-L-Carnitine (also great for heart disease, neuropathy, muscle wasting [= HIV, Tuberculosis, or cancer in our Haitian practice] and exercise performance), Huperzine-A, and Piracetam – the last 2 are my favorite overall brain supplements because of their broad actions and quick onset.

Huperzine-A is derived from Huperzia Serrata, Chinese Club Moss.  It is an Acetylcholinesterase Inhibitor, meaning that in nerve synapses, it prevents the breakdown of Acetylcholine.  Strong/irreversible peripherally-acting Acetylcholinesterase Inhibitors are poisons – nerve gas and orphanophosphates (pesticides on your fruits/vegetables!) are Acetylcholinesterase Inhibitors.  Some are medicines – Donepezil (Aricept) is a very common treatment for Alzheimer’s.  Huperzine-A is comparable and has other brain-boosting benefits as well.  Typical doses are 100mcg-200mcg one to three times per day.  NOT good for people with obstructive urinary retention.

Piracetam is more hit-or-miss (some people do not respond) but has broader actions than Huperzine.  It increases the function and number of Acetylcholine receptors in the brain, and also increases Serotonin and Dopamine receptors.  Glucose utilization increases and traffic across the Corpus Callosum increases – essentially it helps to connect the right and left side of your brain.  There is evidence from animal models that it protects the brain against damage from hypoxia (think strokes) and anticholinergic compounds.  Doses vary widely, from 2400mg-7200mg 2-3 times per day, with a cumulative effect over time allowing for reduced doses.  It is best to take with a choline source as well – 1tbsp Lecithin, 500mg Choline, 300mg CDP-Choline, 200mg DMAE, or 100-200mg .  Centrophenoxine is very expensive.

Rosemary is a mild Acetylcholinesterase inhibitor and has compounds which have been found to inhibit some of the mechanisms of Alzheimer’s and oxidative damage.  Traditionally, it is used to boost memory and increase circulation in the brain.  A couple drops of oil in a diffuser or 100-200mg of extract is sufficient.  When studying for NPLEX Basic Science boards I would take a dropper of the alcohol extract every 2 hours (back when they had separate tests J) but it’s a VERY strong taste.

Bacopa Monnieri is an Ayurvedic herb traditionally used to boost memory and for stress in general.  It is a top Adaptogen, meaning it helps the body to respond to many kinds of stress.  Modern science has revealed that it helps thyroid hormone activate while protecting the thyroid from oxidative damage (great for Hashimoto’s Thyroiditis).   Memory storage/recall increases after 8-12weeks of a 200mg daily dose.  The timing of this article is perfect for students beginning to study for boards in August – 200mg of Bacopa 2x/day (once right before bed because it is also a nervine which will help you fall asleep) will be kicking in about the time you are cramming J.  Pure Encapsulations’s Daily Stress Formula has 200mg per 3 caps and is a great overall blend for the stresses of life.

Focus/concentration – staying on-task is extremely important for almost anything you’re trying to accomplish, short-term or long-term.  ADHD is the classic pathology, but we’ve all had trouble honing in on a particular task.  The question is why?  Do you have a mental block preventing you from overcoming an obstacle?  Not enough motivation and needing more positive/negative reasons to get the job done?  Needing some goal-setting and a game-plan to break down a larger task?

I’m a big fan of Tim Ferriss’s 4-Hour Workweek, which gives much attention to attention.  To reduce distraction from external and internal processes, try checking email only twice per day and going on the Low Information Diet – no news, TV, or reading (except for pleasure) for 2 weeks.  You will find that you are more able to focus on tasks once endless distractions are minimized.

Glycine is an inhibitory neurotransmitter and amino acid you can get through food or supplementation.  It is a “non-essential” amino acid, meaning you don’t need to ingest it because your body will make it from Serine.  But supplementing has numerous benefits, including decreasing anxiety, turning off mental chatter, helping you focus on a single task, and increasing the clearance of toxic compounds from your liver (for you ND students: it’s one of the amino acids which conjugate in Phase 2 detox).  Dr. Schwaiger (http://www.wellintent.com) got me into Glycine, and he prefers dosing it under the tongue and holding it in the mouth until it dissolves.  It has a calming effect in the gut but I agree that sublingual dosing is superior for mental benefits and rapid absorption (it’s a small amino acid, passively absorbed) – 1-3g 1-3x/day.  Metabolic Maintenance makes Glycine Sticks which contain 3g, about $8 for 30 at Natural Partners.  VERY slick when you need it away from home!  Beyond A Century (www.beyond-a-century.com) has inexpensive powder.

Tyrosine is another amino acid, but instead of being an inhibitory neurotransmitter, it creates Epinephrine (Adrenaline), Norepinephrine, and thyroid hormone.  You might think that it would make you more distractable, but it actually helps focus (especially in ADHD) and as a side benefit, increases Dopamine which will aid motivation and low-catecholamine depression.  1g-2g 1-3x/day away from food.

Cholinergics – as previously mentioned.  They really help to hone focus.

Speed and processing are largely determined by having the right mental state and the right fuel.  The previous dietary suggestions will reduce fog, and the remaining is for cholinergics and caffeine in my opinion.  Getting pumped to fast music is my personal favorite, which unfortunately I could not do during Boards!

Endurance is mostly about fuel and timing.  A short competition or exam won’t require you to be in the zone for long, but if you are trying to stay “on” for longer periods of time, eating small meals spaced throughout the day will keep blood sugar more stable.  Eating healthy fats and proteins is extremely important.  As mentioned before, taking cholinergics spaced out over the day will also help.

Creativity is somewhat improved by cholinergics.  I’ve heard good reports from people utilizing Phenylethylamine (PEA), but dosing varies and it may cause headaches.  You naturally produce it from the amino acid Phenylalanine, which is also a great antidepressant and a precursor to Tyrosine.  L-Theanine 200mg is another consideration, especially to enhance relaxation and alpha brain waves.  Creativity varies widely by time of day, having work to do, and your energy level.

I’m reading a book called Thinkertoys which has LOTS of creative thinking techniques – the author argues that creativity is just seeing the world in a different way, and the more lenses you acquire and combine, the more “creative” you will become.  This area is something I would love to learn more about.  If you have suggestions, a whole world of artists, architects and business people would benefit from your knowledge J.

Circulation is a bigger issue with increasing age and atherosclerosis.  Increasing blood flow can drastically improve concentration and memory.

The 2 main herbs for increasing stimulation in the brain are Ginkgo Biloba and Vinca Minor (vinpocetine is the extracted compound).  EVERYONE has heard of Ginkgo but alone and in young well people it doesn’t help.  It is best combined with Centella Asiatica (Gotu Kola).  Vinpocetine is a powerful cerebral vasodilator, and can even cause headaches in susceptible people, even at a low dose typical doses are 5-30mg/day, divided).  Other traditional herbs for increasing blood flow are Capsicum (Cayenne peppers) and Zanthoxylum (Pricky Ash).

Reversing atherosclerosis is less certain and takes more time.  In general, the idea is to reduce damage to the arteries (endothelial dysfunction), and enable repair mechanisms to work (antioxidants).  There is interesting preliminary research on 8oz of daily pomegranate juice decreasing Carotid Artery Intimal Thickness, which is a measure of the thickness of plaques in your carotid arteries via Doppler.  Garlic has long-standing traditional use in reducing plaques and mixed research in reducing cholesterol (take high dose Allicin before bed to reduce cholesterol).  A special form of Vitamin K seems to help sequester calcium from hardened plaques as well.  The best recommendation I have is to follow the dietary focus above – it is clean, full of antioxidants, and will fuel you throughout the day while your body works to reverse old damage.

Vascular dementia occurs when dementia is due to poor blood flow or a previous stroke.  Piracetam, Acetyl-L-Carnitine (1000mg 2x/day), and CoQ10 (100-200mg 2-3x/day with fatty meal) can be helpful here.  The focus is aiding brain cells bereft of oxygen, and increasing the growth of new nerves (Pregnenolone 25mg 2x/day can be helpful here, increasing Brain-Derived Nerve Growth Factor). 

And finally, the 80/20 product to cap off an 80/20 guide: MemoRegen from Karuna.  Each capsule contains:

Vitamin E (d-alpha mixed tocopherols) 75IU (wish it was mixed tocopherols)

Vitamin B1 125mg (wish it was Benfotiamine or Allithiamine)

Vitamin B6 10mg (wish it was P5P)

Folic acid 200mcg (wish it was 5MTHF)

Vitamin B12 500mcg (wish it was Methylcobalamin)

Acetyl-L-Carnitine 250mg

Ginkgo 24% flavones glycosides, 6% terpene lactones 60mg

Huperzine A 100mcg

Vinpocetine 15mg

This is a rough, supplement-focused guide to nootropics, or brain-boosters.  There is a much bigger world of nootropics, but I’ve chosen the top 2-3 for each category for brevity and focus.  I hope it helps you find what you want out of your brain and gives you some tips to get there.  I’m happy to discuss by email: sean.hesler@gmail.com.  Referring back to my original blog Above Average, on a grander scale I hope enhanced focus on self-improvement and cognition will better society and shift us AWAY from the current lowest common denominator, dumbing-down of society.

In being laid-up with sinusitis, I've had the opportunity to get some much-deferred reading time.  I've re-read The 4-Hour Workweek, and sampled or read intros (need to pick my next obsessive target) to 8-business-oriented books, 6 mental masturbatory books, and a fun fiction (World War Z... yes, I skipped The Zombie Survival Guide and no, I never read fiction).

This chunk of the first chapter from Richard Dawkins's newest, The Greatest Show On Earth, wowed me.  If you're not familiar with Richard Dawkins, he's the leading modern-day Darwin bulldog.  His latest book focuses on evidence for evolution, not explaining the processes as his previous books have.  He takes off the gloves in the first chapter:

Chapter 1: Only A Theory?

Imagine that you are a teacher of Roman history and the Latin language, anxious to impart your enthusiasm for the ancient world - for the elegiacs of Ovid and the odes of Horace, the sinewy economy of Latin grammar as exhibited in the oratory of Cicero, the strategic niceties of the Punic Wars, the generalship of Julius Caesar and the voluptuous excesses of the later emperors.  That's a big undertaking and it takes time, concentration, dedication.  yet you find your precious time continually preyed upon, and your class's attention distracted, by a baying pack of ignoramuses (as a Latin scholar you would know better than to say 'ignorami') who, with strong political and especially financial support, scurry about tirelessly attempting to persuade your unfortunate pupils that the Romans never existed.  There never was a Roman Empire.  The entire world came into existence only just beyond living memory.  Spanish, Italian, French, Portuguese, Catalan, Occitan, Romansh: all these languages and their constituent dialects sprang spontaneously and separately into being, and we owe nothing to any predecessor such as Latin.  Instead of devoting your full atention to teh noble vocation of classical scholar and teacher, you are fored to divert your time and energy to a rearguard defence of the proposition that the Romans existed at all: a defence against an exhiition of ignorant prejudice that would make you weep if you weren't too busy fighting it.

If my fantasy of the Latin teacher seems too wayward, here's a more realistic example.  Imagine you are a teacher of more recent history, and your lessons on twentieth-century Europe are boycotted, heckled or otherwise disrupted by well-organized, well-financed and politically muscular gruops of Holocaust-deniers.  unlike my hypothetical Rome-deniers, Holocaust-deniers really exist.  They are vocal, superficially plausible, and adept at seeming learned.  They are supported by the president of at least one crrently powerful state, and they include at least one bishop of the Roman Catholic Church.  Imagine that, as a teacher of European history, you are continually faced with belligerent demands to 'teach the controversy,' and to give 'equal time' to the 'alternative theory' that the Holocaust never happened but was invented by a bunch of Zionist fabricators.  Fashionably relativist intellectuals chime in to insist that there is no absolute truth: whether the Holocaust happened is a matter of personal belief; all points of view are equally valid and should be equally 'respected.'

Excellent read so far. I will inch along for pleasure, and dive into One Simple Idea by Stephen Key for my next obsession :)

I'm learning quickly but I've had a miserable cold and ongoing duties keeping me from practicing much.  I've committed to riding at least a few minutes a day so I can get better.  Ironically any paved road in Haiti is pretty busy/crazy so I've only been off-road... with a road bike.

Most of you who know me probably don't think of me as the biker type.  I didn't either, until I saw a *really* cool documentary called Long Way Round:

It's about actors Ewan McGregor and Charley Boorman - good friends who decided to ride from Scotland to New York.  Much more than a standard vacation or travel experience, it made me think about learning to ride so I could do a trip like that.  Sarah and I actually thought about doing something like that for our honeymoon, but it didn't pan out.  It's going to take a lot more riding experience but I'm on the right terrain for it :)  Dad, are you reading this?  Let's do it!

In other news, we met with the head of the nursing school in Cap yesterday.  He's a spry 84 year old doctor (and every time he meets someone, he says he thinks he's 48 because when he looks in the mirror and holds up 84, it says 48 to him) who is very excited to work with us.  He proposed that they send a few nursing students to our birth center and that we could potentially run a midwife training program for their graduates!  This would be a nice shortcut to MamaBaby Haiti's goal of running its own midwife training program!  We'll make this happen.

Also had a really, really reinforcing Google Chat meeting with some global health friends.  Big things are on the horizon...

Promise I'll be more consistent with writing when I feel better and adapt to the new scheduling we're trying here.  Hopefully the power company cooperates :)

Which color?

Red, Blue, or Black :)

Seven Second Summary: we are feeding patients, meeting awesome volunteers, and (briefly) returning to the US.  Brace yourself.

Operation Happymeal, or Mange Kontan, is the name of Susan Moray’s and Nancy Becker’s idea for a way to provide food for our patients-to-be in the waiting room.  They usually show up around 5am and can wait 10 hours to be seen.  With some seed money from Susan and Nancy, Santo is managing the small business – Jason’s girlfriend brings utensils and plates, and cooks rice/beans with vegetables and some meat.  On the 2 clinic days, they have sold out and made a decent profit, with a big loss on prenatal day.  This may be due to the pregnant ladies not expecting to stay as long and not knowing about food availability.  So after some troubleshooting, we think we’ve got it working and the patients seem happier by the end of the day when we all start dragging from a long day J

Joe and Co – Joe Perkins has been in contact with MamaBaby Haiti since before we landed in November, helping to coordinate the garden.  A week ago, he showed up with Jamie and Ron, and within a few days had constructed 2 shade houses (see picture) which will greatly increase our yields and allow for a wider variety of plants to grow.  They are great guys, with years of stories working in Haiti.  I greatly miss their positive attitude and undying work ethic!  Check out Joe’s blog: http://sfp2008.blogspot.com

NCNM – Patricia and Jessie gave a talk at National College of Naturopathic Medicine and it was a hit!  60 students showed up and there was a lot of interest.  I hope they organize a trip (I’ve heard they are…) and an NWB chapter once we hang out for a bit J

CCNM – we have 3 interested CCNM students who will be coming in the summer and next winter.  <3 the Canadians

Bastyr – sent 2 weeks of lovely students.  It was so rad to have them, I wrote a blog about it J  LOTS of donations.  They just announced another trip, which will be even more organized and hilarious!   

SCNM – sent 1 week of lovely students.  It was so nice to talk about professors, shifts, and other common experiences.  The pre-clinical students did extremely well and the secondary clinical students were at primary level by the time they left.

NWB – lots of excitement lately.  NWB-SCNM VP Jacob Wolf has been improving the website thanks to input from NWB-Bastyr Co-President Stephanie Culver.  Dr. Geyer is moving to Boston in a few months because her brainy husband Brian matched at Harvard for his ER residency.  He will have some time with Paul Farmer… I am endlessly jealous but so happy for them J  In her new-found spare time she took a rockin vacation to Cambodia and Thailand, read some 4-Hour Workweek, and her new focus has us super excited.  Lots of ideas floating around the group…

We connected Food For The Poor with the orphanage we’ve been supporting through gardening and a clinic.  I went over there with a couple guys from St. Francois des Salles Hospital (you may remember Father Geordani and that ambulance helped us get through the riots to the UN compound in November) and dropped off bags of rice for the children (see picture)

The Medika Mamba people are coming this week to give us some training in their refeeding program.  It’s not something you get in Naturopathic medical school, and this will plug us into their program so we can use those $2000+ in donations that have arrived in the last few days.  Thank you all!

We have created a volunteer listserv for MamaBaby Haiti past, present, and future volunteers to communicate with each other.  So far 14 have joined and it’s going to be a really great way for upcoming volunteers to see what’s been done and for veterans to see their work continued!  So far Kim and Edie have posted.  The Naturopathic Global Medicine Network also continues to expand, up to 59 members and increasing post frequency.  After NWB's trip to Rocky Point this weekend I hope we get some trip reports :)

Sarah and I will be visiting the US from May 25^th through June 13^th or 15^th.  Tentative schedule:

-        Phoenix May 25-June 1^st

-        Oregon June 1^st-8^th?

-        California June 8^th-13/15^th

We want to see lots of friends and family, so mark your calendars!