Podcasts about provigil

Modafinil (sold as Provigil®) is a prescription stimulant used to treat sleep disorders like narcolepsy and shift work disorder. However, many people—including students, professionals, and entrepreneurs—use it off-label as a “smart drug” to boost focus, productivity, and mental performance. But what happens if you take modafinil while on hormonal birth control? Does it make contraception less effective? Are there any benefits—or just risks? This guide https://modafinil.org/modafinil-and-birth-control/ covers everything you need to know about mixing modafinil and birth control pills.As discussed in the guide, modafinil revs up your liver enzymes, making them break down contraceptive hormones faster—meaning your birth control pills, patches, or rings could become significantly less effective. It can slash estrogen levels by up to 18%, increasing the chance of pregnancy. And if pregnancy does happen, modafinil's FDA Pregnancy Category C status means there's a risk of harm to the fetus. Some wonder if combining the two could help with focus or mood swings, but the reality is, the risks far outweigh any possible perks. Hormonal birth control already comes with side effects like nausea and emotional ups and downs, and modafinil might make those worse while sabotaging your contraception.So what's the safer move? Is there any interaction? Does the mix affect your health? Always check with your physician to find a birth control method that keeps you protected without messing with modafinil's brain-boosting benefits.Timestamp00:45 What Is Modafinil Drug?03:19 Basics about Modafinil and Birth Control05:14 Modafinil & Birth Control from a Scientific Point of View07:11 Benefits of Modafinil07:42 Long-Lasting Wakefulness Effects09:23 Helps Highly Impulsive Individuals Inhibit Bad Behaviors10:15 Improves Logical & Emotional Intelligence10:51 Ameliorates Memory and Executive Function11:23 Beats Fatigue11:50 Ameliorates Cognitive Performance in Non-Sleep-Deprived Individuals12:16 Improves Mood and Motivation for Work12:50 Weight Loss14:11 Benefits of Birth Control14:26 May Ameliorate Verbal Memory15:05 May Foster Working Memory and Attention15:26 Could Elevate Resilience to Stress16:10 Benefits of Mixing Birth Control Pills and Modafinil16:44 Can Ameliorate Emotional Memory17:09 May Lessen ADHD Symptoms17:47 Can Ameliorate Quality of Sleep18:18 Can Help Control Depression19:23 Possible Side Effects of Taking These Drugs Together23:10 Modafinil & Birth Control Tabs: Is It Worth the Risk?

Lords: * Jeff * https://dopeassvideogames.com/ * Danny * https://www.youtube.com/@NoclipDocs Topics: * What's happening on Bluesky. * Using Google Earth and YouTube to rid myself of Nostalgia of Places I've lived * Dad talk: what do we do about porn? Microtopics: * The Good Morning America series finale. * Covering video games online. * Getting married and feeling safe from people who run dating sites. * Nintendo Disasters. * Reviewing every individual version of FIFA 2011. * The Sega Master System catalog. * Choosing not to do something because someone else has done it before. * A Weird Slop of People. * The CD-32 version of Alfred Chicken. * The Noclip documentary about PiCoSteveMo. * Blood and Fear and Nolf and Shogo and Condemned. * A hardware Pico-8 solution. * Explaining how to and how not to reply. * Enjoying social media because you need a place to type your garbage. * An Eternal September Situation. * Repeating Daily Show jokes from five years ago. * An oral history of Bluesky users. * Jimmy Fallon posting a picture of himself holding a Nintendo Switch. * The Ford vs. Chevy argument over and over again until we're all dead. * Laying your employees off based on their Klout scores. * What aspects of social media you can leave behind once you get a goat farm. * Having goats and not even posting pictures of them. * Goats as a gateway drug to other ungulates. * Did I get drunk and order 20 snakes again? * Boxcars: Where the Hobos Go. * Jumping in a train car full of refined materials. * Reminiscing about the time you lived in London and remembering everything that sucks about living in London. * A warped melting representation of your childhood memories. * An emotional VR moment. * Floating in space and hearing a cacophony of national anthems screaming up at you. * That time they added your uncle's farm to Google Street View. * Looking back on previous eras of your life and remembering why you don't want that kind of life any more. * The guy you know who mined bitcoins on his CPU and then spent it on black market Provigil. * Why do something that's going to make money when you can do ridiculous bullshit instead? * Three year olds who know how to use a remote control. * Areas of human interaction that you are just not prepared for. * Just putting your Zip disk in the file server and grabbing whatever's there. * What kind of porn the owner of the video rental place is personally obsessed with. * Why do you never see porn scored with tracker music? * Deep appreciation of porn that is made for somebody else * Beavis and Butthead trading cards. * Scintillating pizza delivery. * Explaining to your child that porn is fictional, not a documentary, and leaving it at that. * Your daughter asking you questions about Sonic the Hedgehog that you're not prepared to answer. * Encountering boys who play Minecraft. * Deploying new words to the wrong people. * Laying in bed and cursing at ghosts to calm yourself down. * An entire generation who goes to the gym and doesn't just watch CKY2K and break things. * Doing all the drugs so that you can explain what drugs are like to your children. * Learning how to fall as a child so you can fall safely as an adult. * Smoking Ice and waking up in San Francisco. * Pulling over, opening the hood, and punching the engine block over and over. * A poem that somebody else will read. * Whether the money has changed the Dwarf Fortress developers.

Modafinil and armodafinil are popular meds used to treat excessive daytime sleepiness & off-label for various health conditions including ADHD, age-related cognitive decline, & multiple sclerosis, and as a cognitive augmenter by healthy people. However, they have some key differences that might influence which one you choose. Modafinil is sold under the brand name Provigil®, while armodafinil is marketed as Nuvigil®. So, what's the difference between these meds, and which one is the better option for you? This guide https://modafinil.org/modafinil-vs-armodafinil/ provides a detailed comparison between modafinil vs armodafinil, highlighting their differences in chemical structure, effects, and side effects. Modafinil is a racemic compound, meaning it contains both (R) and (S) enantiomers, while armodafinil is enantiopure, containing only the stronger (R)-enantiomer. As a result, armodafinil tends to have a more potent effect, with a quicker onset and a longer duration of effect, compared to modafinil. Ultimately, modafinil is preferred by people seeking more moderate effects, while armodafinil suits those needing a stronger, quicker response. Timestamp 00:36 What Is Modafinil? 00:54 What Is Armodafinil? 01:54 Where to Buy Modafinil & Armodafinil 02:13 The Differences Between Modafinil & Armodafinil Include 02:26 1. Duration of Effects 02:45 2. Onset of Effects 03:02 3. Side Effects 03:28 The 3 Evolutions of Modafinil 03:35 Generation 1: Adrafinil 04:57 Generation 2: Modafinil 05:58 Along Came Cephalon Inc 07:02 Generation 3: Armodafinil 07:55 What the Modafinil Market Looks Like Today 09:11 Modafinil vs. Armodafinil: Which Is Better? 09:46 Armodafinil Is Stronger Than Modafinil 10:25 Modafinil Is Cheaper Than Armodafinil 10:44 In Summary

This episode is presented by Carolina Readiness Supply – According to former White House Chief of Staff, Mick Mulvaney, the drug modafinil (or "Provigil") is in the White House medicine cabinet. He knows because he took it... and he says it works. Subscribe to the podcast at: https://ThePeteKalinerShow.com/  All the links to Pete's Prep are free: https://patreon.com/petekalinershow Get exclusive content here!: https://thepetekalinershow.com/See omnystudio.com/listener for privacy information.

In the world of nootropics, substances designed to enhance cognitive function, modafinil stands out as a game-changer. Unlike traditional stimulants, modafinil offers significant cognitive benefits with fewer negative effects, making it a popular choice among professionals seeking to boost their mental performance and achieve an edge. Originally developed for sleep disorders like narcolepsy, modafinil's off-label use has expanded as individuals across various fields — including business, athletics, coders, and academia — discover its potential for enhancing wakefulness, cognition, and productivity. Modalit, a generic version of the branded modafinil drug Provigil, provides an affordable and effective alternative for those seeking cognitive enhancement. This comprehensive guide https://modafinil.org/modalit/ delves into the various aspects of Modalit, including its benefits, dosage recommendations, potential negative effects, and legal considerations. Furthermore, the Modalit review guide explores where to buy Modalit pills, highlighting reputable sources. It discusses the cost of Modalit compared to Provigil, emphasizing its affordability without compromising efficacy. Legal considerations surrounding the purchase and use of Modalit are addressed, along with comparisons between Modalit and other meds like Provigil and Vigilit. The benefits of Modalit are detailed, covering aspects such as boosted productivity, augmented mental clarity & problem-solving abilities, enhanced learning capacity & improved decision-making abilities, heightened attention span and concentration capabilities, boosted working memory, enhanced motivation & energy, increased mental stamina & productivity, and cognitive function. The guide also explains Modalit's mechanism of action, the recommended dosage, and potential negative effects. Additionally, it addresses concerns about addiction and interactions with food, alcohol, and other drugs. The podcast also provides detailed information on flmodafinil, including its recommended dosage, how it works in the brain to enhance cognitive function, its unique benefits compared to other nootropics, the practice of microdosing flmodafinil for subtle yet effective results, potential negative effects and warnings, and what to do in case of an overdose. Furthermore, it includes an in-depth comparison between flmodafinil and modafinil, helping users understand the differences and make informed decisions about which substance might be better suited to their needs. Timestamp 00:43 What Is Modalit? 01:11 Where to Buy Modalit 200mg Pills? 02:13 What Is the Cost of Modalit? 02:26 Why is Modalit Much Cheaper than Provigil? 03:04 How Does this Drug Work? 03:31 How Much Modalit Should You Take? 03:49 What About Interactions With Food, Alcohol, & Other Drugs? 04:01 Benefits of Modalit 200 mg 04:35 Flmodafinil Dosage Guide 05:40 How Flmodafinil Work 06:06 Flmodafinil Side Effects 06:30 Flmodafinil Warnings 06:46 Flmodafinil Dosage Guide 09:44 About Flmodafinil Microdosing 10:25 Flmodafinil Overdose 11:17 Flmodafinil vs Modafinil

After finishing her training in neurology at Mayo Clinic, Dr. Svetlana Blitshteyn started a Dysautonomia Clinic in 2009. Little did she know what was in store many years later when Covid hit!Ground Truths podcasts are on Apple and Spotify. The video interviews are on YouTubeTranscript with audio and external linksEric Topol (00:07):Well, hello, it's Eric Topol from Ground Truths, and I have with me a really great authority on dysautonomia and POTS. We will get into what that is for those who aren't following this closely. And it's Svetlana Blitshteyn who is a faculty member at University of Buffalo and a neurologist who long before there was such a thing as Covid was already onto one of the most important pathways of the body, the autonomic nervous system and how it can go off track. So welcome, Svetlana.Svetlana Blitshteyn (00:40):Thank you so much, Eric for having me. And I want to say it's a great honor for me to be here and just to be on the list with your other guests. It's remarkable and I'm very grateful and congratulations on being on the TIME100 Health list for influential people in 2024. And I am grateful for everything that you've done. As I mentioned earlier, I'm a big fan of your work before the pandemic and of course with Covid I followed your podcast and posts because you became the best science communicator and I'm very happy to see you being a strong advocate and thank you for everything you've done.Eric Topol (01:27):Well, that's so kind to you. And I think talking about getting things going before the pandemic, back in 2011, you published a book with Jodi Epstein Rhum called POTS - Together We Stand: Riding the Waves of Dysautonomia. And you probably didn't have an idea that there would be an epidemic of that more than a decade later, I guess, right?Svetlana Blitshteyn (01:54):Yeah, absolutely. Of course, SARS-CoV-2 is a new virus and we can technically say that Long Covid and post Covid complications could be viewed as a new entity. But practically speaking, we know that post-infectious syndromes have been happening for many decades. And so, the most common trigger for POTS happened to be infection, whether it was influenza or mononucleosis or Lyme or enterovirus. We knew this was happening. So I think it didn't take long for me and my colleagues to realize that we're going to be seeing a lot of patients with autonomic dysfunction after Covid.On the Front LineEric Topol (02:40):Well, one of the things that's important for having you on is you're in the front lines taking care of lots of patients with Long Covid and this postural orthostatic tachycardia syndrome (POTS). And I wonder if you could tell us what it's care for these patients because so many of them are incapacitated. As a cardiologist, I see of course some because of the cardiovascular aspects, but you are dealing with this on a day-to-day basis.Svetlana Blitshteyn (03:14):Yeah, absolutely. As early as April 2020 when everything was closed, I got a call from a young doctor in New York City saying that he had Covid and he couldn't recover, he couldn't return to the hospital. And his colleagues and cardiology attendants also had the same symptoms and the symptoms were palpitations, orthostatic intolerance, tachycardia, fatigue. Now, how he knew to contact me is that his sister was my patient with POTS before Covid pandemic. So he kind of figured this looked like my sister, let me check this out. And it didn't take long for me to have a lot of patience from the early wave. And then fairly soon, I think within months I was thinking, we have to write this up because this is important. And to some of us it was not news, but I was sure that to many physicians and public health officials, this would be something new.Svetlana Blitshteyn (04:18):So because I'm a busy clinician and don't have a lot of time for publications, I had to recruit a graduate student from McMasters and together we had this paper out, which was the first and largest case series on post Covid POTS and other autonomic disorders. And interestingly, even though it came out I think in 2021, by the time it was published, it became the most citable paper for me. And so I think from then on organizations and societies became interested in the work that I do because prior to that, I must say in the kind of a niche specialty was I don't think it was very popular or of interest to me.How Did You Get Interested in Dysautonomia?Eric Topol (05:06):Yeah, so that's why I wanted to just take a step back with you Svetlana, because you had the foresight to be the founder and director of the Dysautonomia Clinic when a lot of people weren't in touch with this as an important entity. What prompted you as a neurologist to really zoom in on dysautonomia when you started this clinic?Svetlana Blitshteyn (05:28):Sure. So the reasons are how I ended up in this field is kind of a convoluted road and the reasons are many, but one, I will say that I trained at Mayo Clinic where we received very good training on autonomic disorders and EMG and coming back to returning back to Buffalo, I began working at the large multiple sclerosis clinic because Western New York has a high incidence MS. And so, what they quickly realized in that clinic is that there was a subset of women who did not qualify for the diagnostic criteria of multiple sclerosis, yet they had a lot of the same symptoms and they were certainly very disabled. Now I recognize that these women had autonomic disorders of all sorts and small fiber neuropathy, and I think this population sort of grew and eventually I realized there is no one not only in Buffalo but the entire Western New York who is doing this work.Svetlana Blitshteyn (06:34):So I kind of fell into that. But another reason is actually more personal that I haven't talked about. So years ago I was traveling to Toronto, Canada for a neurology meeting to present my big study on meningioma and hormone replacement therapy using Mayo Clinic database. And so, in that year, the study received top 10 noteworthy studies of the year award from the Society of Neuro-Oncology, and it was profiled in Reuters Health. Now, on the way back from the conference, I had the flu, and when they returned I could no longer walk the same hallways of the hospital where I walked previously. And no matter how hard I try to push my body, we all do this in medicine, we push through, I just couldn't do it. No amount of wishing or positive thinking. And so, I think that's how I came to know personally the post-infectious syndromes. And I think it almost became a duality of experiencing this and also practicing it.Eric Topol (07:52):No, that's really striking and it wasn't so common to hear about this post flu, but certainly it changed in 2020. So how does a person with POTS typically present to you?Clinical PresentationSvetlana Blitshteyn (08:08):So these are very important questions because what I want to stress is though POTS is one of the most common autonomic disorders. Even if you don't have POTS by the diagnostic criteria, you may still have autonomic dysfunction and significant autonomic symptoms. How do they present? Well, they present like most Long Covid patients, the most common symptoms are orthostatic intolerance, fatigue, exercise intolerance, post exertional malaise, dizziness, tachycardia, brain fog. And these are common themes across the board in Long Covid patients, but also in pre-Covid post-acute infection syndrome patients. And you have to recognize because I think what I tell my colleagues is that oftentimes patients are not going to present to you saying, I have orthostatic intolerance. Many times they will say, I'm very tired. I can no longer go to the gym or when I go to the store, I have to be out of there in 15 minutes because the orthostatic intolerance symptoms come up.Svetlana Blitshteyn (09:22):So sometimes the patients themselves don't recognize that and it's up to us physicians to ask the right questions to get the information down. History is very important, knowing the pattern. And then of course, as I always say in all of my papers and lectures, you have to do a 10-minute stand test by measuring supine and standing blood pressure and heart rate on every Long Covid patients. And that's how you spot those that have excessive postural tachycardia or their blood pressure dropping or so forth. So we have the tools. We don't need fancy autonomic labs. We don't even need a tilt table test. The diagnostic criteria for POTS is that you need to have either a 10-minute stand test or a tilt table test to get the diagnosis for POTS, orthostatic hypotension or even neurocardiogenic syncope. Now I think it's important to stress that even if a patient doesn't qualify, and let's say many patients with Long Covid will not elevate their heart rate by at least 30 beats per minute, it could be 20, it could be 25. These criteria are of course essential when we do research studies. But I think practically speaking, in patient care where everything is gray and nothing is black or white, especially in autonomic disorders, you really have to make a diagnosis saying, this sounds like autonomic dysfunction. Let me treat the patient for this problem.Eric Topol (11:07):Well, you brought up something that's really important because doctors don't have much time and they're inpatient. They don't wait 10 minutes to do a test to check your blood pressure. They send the patients for a tilt table, which nobody likes to have that test done, and it's unnecessary added appointment and expense and whatnot. So that's a good tip right there that you can get the same information just by checking the blood pressure and heart rate on standing for an extended period of time, which 10 minutes is a long time in the clinic of course. Now, what is the mechanism, what do you think is going on with the SARS-CoV-2 virus and its predilection to affect the autonomic nervous system? As you know, so many studies have questioned whether you even actually infect neurons or alternatively, which is more likely this an inflammation of the neural tissue. But what do you think is going on here?UnderpinningsSvetlana Blitshteyn (12:10):Right, so I think it's important to say we don't have exact pathophysiology of what exactly is going on. I think we can only extrapolate that what's going on in Long Covid is possibly what's going on in any post infectious onset dysautonomia. And so there are many hypothesis and there are many suggestions, and we share this disorder with cardiologist and immunologist and rheumatologist. The way I view this is what I described in my paper from a few years ago is that this is likely a central nervous system disorder with multisystemic involvement and it involves the cardiovascular system, immunologic, metabolic, possibly prothrombotic. The pathophysiology of all POTS closely parallels to pathophysiology of Long Covid. Now we don't know if it's the same thing and certainly I see that there may be more complications in Long Covid patients in the realm of cardiovascular manifestations in the realm of blood clots and things like that.Svetlana Blitshteyn (13:21):So we can't say it's the same, but it very closely resembles and I think at the core is going to be inflammation, autoimmunity and immunologic dysfunction. Now there are also other things that are very important and that would be mitochondrial dysfunction, that would be hypercoagulable state, it would be endothelial dysfunction. And I think the silver lining of Long Covid and having so many people invested in research and so many funds is that by uncovering what Long Covid is, we're now going to be uncovering what POTS and other autonomic disorders are. And I think we also need to mention a couple of other things. One is small fiber neuropathy, small fiber neuropathy and POTS are very much comorbid conditions. And similarly, small fiber neuropathy frequently occurs in patients with Long Covid, so that's a substrate with the damaged small nerve fibers that they're everywhere in our bodies and also innervate the organs as well.Svetlana Blitshteyn (14:34):The second big thing is that needs to be mentioned is hyperactive mast cells. So mast cells, small nerve fibers and capillaries are very much located in proximity. And what I have usually is a slide from an old paper in oral biology that gives you a specimen where you see a capillary vessel, a stain small nerve fiber, and in between them there is a mass cell with tryptase in it stained in black. And so there is a close communication between small nerve fibers between endothelial wall and between mast cells, and that's what we commonly see as a triad. We see this as a triad in Long Covid patients. We see that as a triad in patients with joint hypermobility syndrome and hypermobile EDS, and you also see this in many of the autoimmune disorders where people develop new allergies and new sensitivities concurrent or preceding the onset of autoimmune disease.Small Fiber NeuropathyEric Topol (15:49):Yeah, no, it's fascinating. And I know you've worked with this in Ehlers-Danlos syndrome (EDS) as you mentioned, the hypermobility, but just to go back on this, when you want to entertain the involvement of small fiber neuropathy, is that diagnosable? I mean it's obvious that you can get the tachycardia, the change in position blood pressure, but do you have to do other tests to say there is indeed a small fiber neuropathy or is that a clinical diagnosis?Svetlana Blitshteyn (16:20):Absolutely. We have the testing and the testing is skin biopsy. That is simply a punch biopsy that you can do in your clinic and it takes about 15 minutes. You have the free kit that the company of, there are many companies, I don't want to name specific ones, but there are several companies that do this kind of work. You send the biopsy back to them, they look under the microscope, they stain it. You can also stain it with amyloid stain to rule out amyloidosis, which we do in neurology, and I think that's quite accessible to many clinicians everywhere. Now we also have another test called QSART (quantitative sudomotor axon reflex test), and that's a test part of autonomic lab. Mayo Clinic has it, Cleveland Clinic has it, other big labs have it, and it's hard to get there because the wait time is big.Svetlana Blitshteyn (17:15):Patients need to travel. Insurance doesn't always authorize, so access is a big problem, but more accessible is the skin biopsy. And so, by doing skin biopsy and then correlating with neurologic exam findings, which oftentimes involved reduce pain and temperature sensation in the feet, sometimes in the hands you can conclude that the patient has small fiber neuropathy and that's a very tangible and objective diagnosis. There again, with everything related to diagnostics, some neuropathy is very patchy and the patchy neuropathy is the one that may not be in your feet where you do the skin biopsy. It may be in the torso, it may be in the face, and we don't have biopsy there. So you can totally miss it. The results can come back as normal, but you can have patchy type of small fiber neuropathy and there are also diagnostic tests that might be not sensitive to pick up issues. So I think in everything Long Covid, it highlights the fact that many tests that we use in medicine are outdated perhaps and not targeted towards these patients with Long Covid. Therefore we say, well, we did the workup, everything looks good. MRI looks good, cardiac echo looks great, and yet the patient is very sick with all kinds of Long Covid complications.Pure Post-Viral POTS?Eric Topol (18:55):Right. Now, before we get into the treatments, I want to just segment this a bit. Can you get pure POTS that is no Long Covid just POTS, or as you implied that usually there's some coalescence of symptoms with the usual Long Covid symptoms and POTS added to that?Svetlana Blitshteyn (19:21):So the studies have shown for us that about 40% of patients with POTS have post-infectious onset, which means more than a half doesn't. And so of course you can have POTS from other causes and the most common is puberty, hormonal change, the most common age of onset is about 13, 14 years old and 80% of women of childbearing age and other triggers or pregnancy, hormonal change again, surgery, trauma like concussion, post-concussion, autonomic dysfunction is quite common.Eric Topol (20:05):So these are pure POTS without the other symptoms. Is that what you're saying in these examples?Svetlana Blitshteyn (20:12):Well, it's a very good question. It depends what you mean by pure POTS, and I have seen especially cardiologists cling to this notion that there is pure POTS and then there is POTS plus. Now I think majority of people don't have pure POTS and by pure POTS I think you mean those who have postural tachycardia and nothing else. And so most patients, I think 80% have a number of symptoms. So in my clinic I almost never see someone who is otherwise well and all they have is postural tachycardia and then they're having a great time. Some patients do exist like that, they tend to be athletic, they can still function in their life, but majority of patients come to us with symptoms like dizziness, like fatigue, like exercise intolerance, decline in functioning. So I think there is this notion that while there is pure POTS, let me just fix the postural tachycardia and the patient will be great and we all want that. Certainly sometimes I get lucky and when I give the patient a beta blocker or ivabradine or a calcium channel blocker, sometimes we use it, certainly they get better, but most patients don't have that because the disability that drives POTS isn't actually postural tachycardia, it's all that other stuff and a lot of it's neurologic, which is why I put this as a central nervous system disorder.TreatmentsEric Topol (21:58):Yeah, that's so important. Now you mentioned the treatments. These are drug treatments, largely beta blockers, and can you tell us what's the success rate with the various treatments that you use in your clinic?Svetlana Blitshteyn (22:13):So the first thing we'll have to mention is that there are no FDA approved therapies for POTS, just like there are no FDA approved therapies for Long Covid. And so, everything we use is off label. Now, oftentimes people think that because it wasn't evidence-based and there are no big trials. We do have trials, we do have trials for beta blockers and we know they work. We have trials for Midodrine and we know that's working. We also have fludrocortisone, which is a medication that improves sodium and water resorption. So we know that there are certain things we've used for decades that have been working, and I think that's what I was trying to convey in this paper of post Covid autonomic dysfunction assessment and treatment is that when you see these patients, and you can be of any specialty, you can be in primary care, you can be a physiatrist, a cardiologist, there are things to do, there are medications to use.Svetlana Blitshteyn (23:20):Oftentimes colleagues would say, well, you diagnose them and then what do you treat them with? And then I can refer them to table six in that paper and say, look at this list. You have a lot of options to try. We have the first line treatment options, which are your beta blockers and Midodrine and Florinef and Mestinon. And then we have the second line therapies you can choose from the stimulants are there Provigil, Nuvigil, Wellbutrin, Droxidopa is FDA approved for neurogenic orthostatic hypotension. Now we don't use it commonly, but it can still be tried in people whose blood pressures are falling on your exam. So we have a number of medications to choose from in addition to non-pharmacologic therapies.Eric Topol (24:14):Right now, I'm going to get to the non-pharmacologic in a moment, but the beta blocker, which is kind of the first one to give, it's a little bit paradoxical. It makes people tired, and these people already are, don't have much energy. Is the success rate of beta blocker good enough that that should be the first thing to try?Svetlana Blitshteyn (24:35):Absolutely. The first line medication treatment options are beta blockers. Why? Okay, why are they working? They're not only working to reduce heart rate, but they may also decrease sympathetic overactivity, which is the driving mechanism of autonomic dysfunction. And when you reduce that overactivity, even your energy level can improve. Now, the key here is to use a low dose. A lot of the time I see this mistake being done where the doctor is just prescribing 25 milligrams of metoprolol twice a day. Well, this is too high. And so, the key is to use very low doses and to use them and then increase them as needed. We have a bunch of beta blockers to choose from. We have the non-selective propranolol that you can use when someone maybe has a migraine headache or significant anxiety, they penetrate the brain, and we have non-selected beta blockers like atenolol, metoprolol and others that you can use at half a tablet. Sometimes I start my patients at quarter of tablet and then go from there. So low doses will block tachycardia, decrease sympathetic overactivity, and in many cases will allow the patient to remain upright for longer periods of time.Eric Topol (26:09):That's really helpful. Now, one of the other things, I believe it's approved in Canada, not in the US, is a vagal neuromodulation device. And I wonder, it seems like it would be nice to avoid drugs if there was a device that worked really well. Is there anything that is in the hopper for that?Svetlana Blitshteyn (26:32):Yeah, absolutely. Non-invasive vagus nerve stimulator is in clinical trials for POTS and other autonomic disorders, but we have it FDA for treatment of migraine and cluster headaches, so it's already approved here and it can also be helpful for chronic pain and gastroparesis. So there are studies on mice that show that with the application of noninvasive vagus nerve stimulator, there is reduction of pro-inflammatory cytokines. So here is this very important connection that comes from Kevin Tracey's work that showed inflammatory reflex, and that's a reflex between the vagus nerve and the immune system. So when we talk about sympathetic overactivity, we need to also think about that. That's a mechanism for pro-inflammatory state and possibly prothrombotic state. So anything that decreases sympathetic overactivity and enhancing parasympathetic tone is going to be good for you.Eric Topol (27:51):Now, let's go over to, I mean, I'm going to get into this body brain axis in a moment because there's another part of the story here that's becoming more interesting, fascinating, in fact every day. But before I do that, you mentioned the small fiber neuropathy. Is there a specific treatment for that or is that just something that is just an added dimension of the problem without a specific treatment available?Svetlana Blitshteyn (28:21):Yeah, we certainly have treatment for small fiber neuropathy. We have symptomatic treatment for neuropathic pain, and these medications are gabapentin, pregabalin, amitriptyline and low dose naltrexone that have been gaining popularity. We used that before the pandemic. We used low dose naltrexone for people with chronic pain related to joint hypermobility. And so, we have symptomatic, we also have patches and creams and all kinds of topical applications for people with neuropathic pain. Then we also have, we try to go for the root cause, right? So the number one cause of small fiber neuropathy in the United States is diabetes. And certainly, you need to control hyperglycemia and in some patients you only need a pre-diabetic state, not even full diabetes to already have peripheral neuropathy. So you want to control blood glucose level first and foremost. Now then we have a big category of autoimmune and immune mediated causes, and that's where it gets very interesting because practical experience from many institutions and many neurologists worldwide have shown that when you give a subset of patients with autoimmune small fiber neuropathy, immunotherapy like IVIG, a lot of patients feel significantly better. And so, I think paralleling our field in dysautonomia and POTS, we are looking forward to immunotherapy being more mainstream rather than exception from the rule because access and insurance coverage is a huge barrier for clinicians and patients, but that may be a very effective treatment options for treatment refractory patients whose symptoms do not improve with symptomatic treatment.Eric Topol (30:38):Now, with all these treatments that are on the potential menu to try, and of course sometimes it really is a trial and error to get one that hopefully works for Covid, Long Covid, what is the natural history? Does this persist over years, or can it be completely resolved?Svetlana Blitshteyn (31:00):That's a great question. Everyday Long Covid patients ask me, and I think what we are seeing is that there is a good subset of patients for whom Long Covid is going to be temporary and they will improve and even recover close to normal. Now remember that original case series of patients that I reported in early 2021 based on my 2020 experience in that 20 patient case series, very few recovered, three patients recovered back to normal. Most patients had lingering ongoing chronic symptoms. So of course mine is a kind of a referral bias where I get to see the sickest patients and it looks to be like it's a problem of chronic illness variety. But I also think there is going to be a subset of patients and then we have to study them. We need to study who got better and who didn't. And people improve significantly and some even recover close to normal. But I think certain symptoms like maybe fatigue and heat intolerance could persist because those are very heavily rooted in autonomic dysfunction.Vaccination and POTSEric Topol (32:26):Yeah, well, that's something that's sobering and why we need trials and to go after this in much more intensity and priority. Now the other issue here is while with Covid, this is almost always the virus infection, there have been reports of the vaccine inducing POTS and Long Covid, and so what does that tell us?Svetlana Blitshteyn (32:54):Well, that's a big, big topic. Years ago, I was the first one to report a patient with POTS that was developed after HPV vaccine Gardasil. Now, at that time I was a young neurologist. Then the patient came to me saying she was an athlete saying two weeks after Gardasil vaccine, she developed these very disabling symptoms. And I thought it was very interesting and unique and I thought, well, I'll just publish it. I never knew that this would be the start of a whole different discussion and debate on HPV vaccines. There were multiple reports from numerous countries, Denmark, Mexico, Japan. Japan actually suspended their mass HPV vaccination program. So somehow it became a big deal. Now many people, including my colleagues didn't agree that POTS can begin POTS, small fiber neuropathy, other adverse neurologic events can begin after vaccination in general. And so, this was a topic that was widely debated and the European medical agencies came back saying, we don't have enough evidence.Svetlana Blitshteyn (34:20):Of course, we all want to have a good cancer vaccine. And it was amazing to watch this Covid vaccine issue unfolding where more than one study now have shown that indeed you can develop POTS after Covid vaccines and that the rate of POTS after Covid vaccines is actually slightly higher than before vaccination. So I think it was kind of interesting to see this unfold where I was now invited by Nature Journal to write an editorial on this very topic. So I think it's important to mention that sometimes POTS can begin after vaccination and however, I've always advised my patients to be vaccinated even now. Even now, I have patients who are unvaccinated and I say, I'm worried about you getting a second Covid or third without these vaccines, so please get vaccinated. Vaccines are very important public health measure, but we also have to acknowledge that sometimes people develop POTS, small fiber neuropathy and other complications after Covid vaccines.Prominence of the Vagus Nerve Eric Topol (35:44):Yeah, I think this is important to emphasize here because of all vaccinations can lead to neurologic sequelae. I mean look at Guillain-Barre, which is even more worrisome and that brings in the autoimmune component I think. And of course, the Covid vaccines and boosters have a liability in a small, very small percentage of people to do this. And that can't be discounted because it's a small risk and it's always this kind of risk benefit story when you're getting vaccinated that you are again spotlighting. Now gets us to the biggest thing of all besides the practical pearls you've been coming up with to help everyone in patients and clinicians. In recent weeks, there's been explosion of these intra body circuits. There was a paper from Columbia last week that taught us about the body-brain circuits between the vagus nerve and the caudal Nucleus of the Solitary Tract (cNST) of the brain and how this is basically a master switch for the immune system. And so, the vagus nerve there and then you have this gut to brain story, which is the whole gut microbiome is talking to the brain through the vagus nerve. I mean, everything comes down to the vagus nerve. So you've been working all your career and now everything's coming into this vagus nerve kind of final common pathway that's connecting all sorts of parts of the body that we didn't truly understand before. So could you comment about this because it's pretty striking.Svetlana Blitshteyn (37:34):Absolutely. I think this pandemic is highlighting the pitfalls of everything we didn't know but should have in the past. And I think this is one of them. How important is the autonomic nervous system and how important is the vagus nerve that is the longest nerve in the body and carries the parasympathetic outflow. And I think this is a very important point that we have to move forward. We cannot stop at the autonomic knowledge that we've gained thus far. Autonomic neurology and autonomic medicine has always been the field with fellowship, and we have American Autonomic Society as well. But I think now is a great time to move forward and study how the autonomic nervous system communicates with the immunologic system. And again, Kevin Tracey's work was groundbreaking in the sense that he connected the dots and realized that if you stimulate the vagus nerve and the parasympathetic outflow, then you can reduce pro-inflammatory cytokines and that he has shown that you can also improve or significantly such disorders like rheumatoid arthritis and other autoimmune inflammatory conditions.Svetlana Blitshteyn (39:03):Now we have the invasive vagus nerve stimulation procedures, and quite honestly, we don't want that to be the mainstream because you don't want to have a neurosurgery as you go to treatment. Of course, you want the non-invasive vagus nerve stimulation being the mainstream therapy. But I think a lot of research needs to happen and it's going to be a very much a multidisciplinary field where we'll have immunology, translational sciences, we'll have neurosurgeons like Kevin Tracey, we'll have rheumatologists, neurologists, cardiologists. We'll have a multidisciplinary collaborative group to further understand what's going on in these autoimmune inflammatory disorders, including those of post-infectious origin.Eric Topol (40:02):I certainly agree with all of your points there. I mean, I'm really struck now because the immune system is front and center with so much of what we're seeing with of course Long Covid, but also things like Alzheimer's and Parkinson's and across the board with metabolic diseases. And here we have this connection with your sweet spot of the autonomic nervous system, and we have these pathways that had not been delineated before. I didn't know too much about the cNST of the brain to be such an important connect point for this. And I wonder, so here's another example. Concurrently the glucagon-like peptide 1 (GLP-1) drugs have this pronounced effect on reducing inflammation in the body before the weight loss and in the brain through the gut-brain axis, as we recently discussed with Dan Drucker, have you ever tried a GLP-1 drug or noticed that GLP-1 drugs help people with Long Covid or the POTS problem?Svetlana Blitshteyn (41:12):So I have heard anecdotally people with Long Covid using these drugs for other reasons, saying I feel much better. In fact, I recently had a woman who said, I have never been more productive than I am now on this medication. And she used the word productive, which is important because non-productive implies so many things. It's the brain fog, it's the physical fatigue, it's the mental fatigue. So I think we are, first of all, I want to say, I always said that the brain is not separate from the body. And neurologic manifestations of systemic disease is a very big untapped area. And I think it's not going to be surprising for me to see that these drugs can improve many brain parameters and possibly even neuroinflammation. We don't know, but we certainly need to study this.Eric Topol (42:15):Yeah, it's interesting because statins had been tried for multiple sclerosis, I think maybe not with very clear cut benefit effects, but here you have a new class of drugs which eventually are going to be in pills and not just one receptor but triple receptor, much more potent than what we're seeing in the clinic today. And you wonder if we're onto an anti-inflammatory for the brain and body that could help in this. I mean, we have a crisis here with Long Covid in POTS without a remedy, without adequate resources that are being dedicated to the clinical trials that are so vital to execute and find treatments. And that's just one candidate of many. I mean, obviously there's so many possible ones on the list. So if you could design studies now based on your extraordinary rich experience with Long Covid and POTS, what would you go after right now? What do you think is the thing that's, would it be to evaluate more of these noninvasive, non-pharmacologic treatments like the vagal nerve stimulation, or are there particular drugs that you find intriguing?Svetlana Blitshteyn (43:33):Well, a few years ago we published a case series of patients with severe POTS and nothing helped them, but they improved significantly and some even made close to recovery improvement and were able to return to their careers because they were treated with immunotherapy. So the paper is a subcutaneous immunoglobulin and plasmapheresis and the improvement was remarkable. I say there was one physician there who could not start her residency. She got sick in medical school and could not start her residency due to severe POTS and no amount of beta blockers, Midodrine or Florinef helped her get out the house and out of bed. And therefore, sheer luck, she was able to get subcutaneous immunoglobulin and she improved significantly, finished her residency and is now a practicing physician. So I think when we have these cases, it's important to bring them to scientific community. And I think I'm very excited that hopefully soon we're going to have trials of immunotherapy and immunomodulating treatment options for patients with Long Covid and hopefully POTS in general, I believe in novel, but also repurposed, repurposed treatment.Svetlana Blitshteyn (45:01):IVIG has been used for decades, so it's not a new medication. And contrary to popular belief, it's actually quite safe. It is expensive, it's a blood product, but we are very familiar with it in medicine and neurology. So I think we have to look forward to everything. And as I tell my patients, I'm always aggressive with medications when they come to me and their doctor said something like, well, let's see, it's going to go away on its own or keep doing your salt and fluids intake or wear compression sucks. Well, they're already doing it. It's not helping. And now it's a good time to try everything we have. And I would like to have more. I would like to have immunotherapy available. I would like to have immunosuppressants even tried potentially, and maybe we'll be able to try medication for possible viral persistence. Let's see how that works out. We have other inflammatory modalities out there that can potentially give us the tools. You see, I think being that it's a multifactorial disorder, that I don't think it's going to be one thing for everyone. We need to have a toolbox where we're going to choose what's best for your specific case because when we talk about Long Covid, we have to remember there are many different phenotypes under that umbrella.A Serious MatterEric Topol (46:40):Now, before we wrap up, I mean I guess I wanted to emphasize how there are clinicians out there who discount Long Covid in POTS. They think it's something that is a figment of imagination. Now, on the other hand, you and I especially, you know that people are totally disabled. Certain days they can't even get out of bed, they can't get back to their work, their life. And this can go on and on as we've been discussing. So can you set it straight about, I mean, you are seeing these people every day. What do you have to say to our fellow colleague physicians who tend to minimize and say, this is extremely rare, if it even exists, and that these people have some type of psychiatric problem. And it's really, it's distressing of course, but could you speak to that?Svetlana Blitshteyn (47:39):Absolutely. So as I always say, Long Covid is not a psychiatric or psychological disorder, and it's also not a functional neurologic disorder. Now, having said that, as I just mentioned, brain is not separate from the body. And neurologic manifestations of systemic disease are numerous. We just had a paper out on neurologic manifestations of mast cell activation syndrome. So certainly some patients will develop psychiatric manifestations and some patients will develop major depression, anxiety, OCD or functional neurologic disorder. But those are complications of systemic disease, meaning that you cannot diagnose a patient with anxiety and send them off to a psychologist or a psychiatrist without diagnosing POTS and treating it. And in many cases, when you approach an underlying systemic disorder with the right medications, like dysautonomia for example, all of the symptoms including psychological and psychiatric, tend to improve as well. And certainly, there is going to be a small subset of Long Covid patients whose primary problem is psychiatric.Svetlana Blitshteyn (49:01):And I think that's totally fine. That is not to say that all Long Covid is psychiatric. Some will have significant psychiatric manifestations. I mean, there are cases of post Covid psychosis and autoimmune encephalitis and all kinds of psychiatric problems that people may develop, but I think we can't really stratify well, this is physiologic and this word functional that I'm not a fan of. This is physiologic as we see it on MRI. But here, because we don't see anything on MRI, it means you are fine and can just exercise your way out of it. So I think with this Long Covid, hopefully we'll get answers as to the pathophysiology, but also most importantly, hopefully we'll get these therapies that millions of people before Covid pandemic were looking for.Eric Topol (50:02):Well, I just want to thank you because you were onto this well over 10, 15 years before there was such a thing as Covid, you've dedicated your career to this. These are some of the most challenging patients to try to help and has to be vexing, that you can't get their symptoms resolved no less the underlying problem. And we're indebted to you, Svetlana, because you've really been ahead of the curve here. You were writing a patient book before there were such things as patient activists in Long Covid, as we've seen, which have been so many of the heroes of this whole problem. But thank you for all the work you do. We'll continue to follow. We learned from you about POTS and Long Covid from your work and really appreciate everything you've done. Thank you.Svetlana Blitshteyn (50:58):Thank you so much, Eric, for having me. As I said, it's a great honor for me to be here. Remarkable, amazing. And thank you for all this work that you're doing and being an advocate for our field because we always need great champions to help us move forward in these complicated disorders.********************************The Ground Truths newsletters and podcasts are all free, open-access, without ads.Voluntary paid subscriptions all go to support Scripps Research. Many thanks for that—they greatly helped fund our summer internship programs for 2023 and 2024.Thanks to my producer Jessica Nguyen and Sinjun Balabanoff tor audio and video support at Scripps ResearchNote: you can select preferences to receive emails about newsletters, podcasts, or all I don't want to bother you with an email for content that you're not interested in. Get full access to Ground Truths at erictopol.substack.com/subscribe

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Modafinil, often marketed under the brand name Provigil®, is recognized by the U.S. Food and Drug Administration (FDA) as a wakefulness-fostering agent. While its primary role is in managing sleep disorder conditions like narcolepsy, obstructive sleep apnea, and shift work sleep disorder, it has transcended these boundaries. Its off-label uses extend to addressing conditions like attention deficit hyperactivity disorder (ADHD), depression, and cognitive impairment. Further, modafinil has found a dedicated user base among students, professionals, business executives, and individuals seeking to bolster their cognitive abilities and productivity to achieve an edge. In contrast, Piracetam belongs to the racetam group of nootropics. However, the nootropic may not enjoy the same level of recognition as modafinil, but its safety profile and cognitive-enhancing potential have earned it a place in the world of nootropics. Piracetam's history dates back to the 1960s, and it has been touted for its ability to prevent age-related cognitive decline, assist in epilepsy management, and improve memory. This comprehensive guide https://modafinil.org/piracetam-vs-modafinil/ offers an extensive comparison between modafinil vs Piracetam. It dissects various facets of these nootropics, such as their uses, properties, legal status, forms, recommended dosages, and potential side effects. Timestamp 00:34 What Is Modafinil? 01:10 What Is Piracetam? 02:09 Compare Modafinil vs Piracetam 02:36 Is Modafinil Safer Than Piracetam? 03:03 Where to Buy These Nootropics Online Over-the-Counter? 03:23 ModafinilXL 03:45 BuyModa 04:03 Afinil.com 04:29 FoxDose 04:46 ModaPharma 05:02 DinoSupplies (Closed in 2020) 05:27 Modafinil and Piracetam Dosage 05:49 Are Their Side Effects Different? 06:33 What About Differences in Interactions? 07:15 Conclusion

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Episode 388 Comic Book talk about Evolusion #1 to 4, King Spawn #9, She-Hulk #3. Multiple Sclerosis Health Talk about Modafinil also known as Provigil and other stuff with health and MS. Send comments, questions and tips to kevintheduckpool@gmail.com please help us out by rating and reviewing us and telling a friend. Also check out audio and video versions of Crimson Cowl Comic Club & Under the Cowl podcasts. A fun variety of great people talk comic books, entertainment or whatever and you can see or hear me on many episodes of those podcasts as well with many more great episodes to come out in the future. --- This episode is sponsored by · Anchor: The easiest way to make a podcast. https://anchor.fm/app --- Send in a voice message: https://anchor.fm/kevin-kleinhans/message Support this podcast: https://anchor.fm/kevin-kleinhans/support

Episode 16: On PTSD, Chronic pain approach and CBT compassion with Dr. Leigh Ann Dooley I am so excited about presenting this episode to all of you. Dr. Dooley is a board certified practicing Psychiatrist and currently works at Charlie Norwood VA Medical Center in Augusta, GA. We chatted about so many things including what made her go into Psychiatry, who was her secret weapon in residency training and how she manages to stay above the stress. I loved her straight talk about her approach to PTSD and chronic pain. You will be able to hear and feel she truly cares about her patients. What I loved perhaps most about her is her passion for improvement and leaving things better than she found them. She is currently in the MPH program at Georgia State university, projected to graduate with the MPH degree in May. Because she wants to make things better for people and communities. I know I can find inspiration in that. And last but not the least, she is an ambassador to end the stigma around mental health in brown and black communities. It spoke to my heart when she genuinely sincerely talked about her experience and why she wants to make things better. I am so honored to introduce this human to you. For the sake of disclosure, we do mention two non-FDA approved meds/approaches to pain and its associated symptoms: Provigil and cannabis. On approaching PTSD in general 9:52 Importance of self-compassion 11:39 Delving deeper into trauma focused interventions at 14:10 including prolonged exposure 14:34 How symptoms can initially get worse before they get better 16:30 Her experience with CBT (cognitive behavioral therapy) 24:57 and why ACT is important (acceptance and commitment therapy) Her most rewarding experience 29:31 Her most frustrating experience 32:25 (hint: seeing other humans suffer) Her comments about MPH and pursuing her passions in non-clinical career 33:50 Why she says “nothing is off the table” in chronic pain management at 40:00 Facebook: Leigh Ann Dooley, MD IG: @realdealdocDooley

Brand name meds are super expensive. There's a significant cost saving if a patient decides to order a generic version of Provigil online. Indeed, after legal patents preventing the manufacture of generic versions of meds expires, other certified pharmaceutical companies can step up to the plate to try & manufacture their generic versions such as Vilafinil, Modavinil, Modawake, Modafresh, Modapro, Modaheal, etc. But the big question is; are generic meds similar to brand-name drugs? This https://modafinil.org/vilafinil/ Vilafinil review guide explains this question in detail. It reviews the Vilafinil & afinil family of drugs & some tips about its maker Centurion Laboratories. Read the guide to know more if the company is a reputable one, how Vilafinil compares to other generic modafinil versions, Vilafinil dosage, benefits, & expected negative effects; some tips on the best alternatives to Vilafinil, whether you should buy some Vilafinil tabs online & where's the best place to shop Vilafinil, etc. In the end, you'll be better informed. Timestamp 01:05 The Afinil Family of Drugs 03:15 What Is Vilafinil? 04:27 The Best Place to Buy Vilafinil Online 05:17 Vilafinil vs. Modalert vs. Modvigil 08:57 Alternative Options for Vilafinil 09:05 Why We Don't Like Vilafinil 10:44 The Best Alternatives to Vilafinil 11:19 Where to Buy Them 12:00 Closing Remarks

Patrick has a problem, but he doesn't know how to address it. Fitting in was something Patrick sought after. Whether it be smoking cigarettes or drinking alcohol excessively at parties, Patrick found a way to make it happen. Years of smoking, drinking, and eating excessively lead to health issues. Patrick had amassed a weight of 302 pounds and was suffering from high blood pressure, migraines, sleep apnea, as well as anxiety and depression. Patrick's physician instructed he take 5 medications (Alprazolam, Sertraline, Valsartan, Furosemide, and Provigil) to address his health issues. But Patrick thought otherwise.  Against the doctor's instructions, Patrick sought after a more natural solution. First he began a vegetarian lifestyle and removed alcohol completely from his diet. He also began minding the composition of his foods to avoid artificial ingredients. After doing his own research about health, food, and wellness, Patrick concluded that veganism was the next logical step.  Three months later, Patrick is excited to share the news of his improved mood and weight loss with his physician. On this visit, Patrick was revealed to have lost 122 pounds and lowered his blood pressure from 150/110 to 110/74. Patrick realized these changes were only possible through the support of his family and friends. Knowing how critical a strong support system is to health and wellness, he now strives to BE that support for others. One of his efforts is a weekly podcast show where he opens up about his life to provide transparency to others who may be going through life issues or need to hear positivity for a change. #WeAllCanWin Instagram  www.Instagram.com/thepodotshow  https://instagram.com/clearmind_fitnesspodcast?utm_medium=copy_link Facebook  https://www.facebook.com/ClearMindPat www.Instagram.com/ELT.thepodcast  Dee    Facebook:  www.Facebook.com/deemariehair    Instagram:  www.Instagram.com/deemariehair    YouTube:  www.YouTube.com/deemariehair    Crystal    Instagram  www.Instagram.com/crystalbaldazo    Abby    Instagram:  www.Instagram.com/theabigailmarie    Facebook:  www.facebook.com/abigailmarieartistry                   

CPI Capital has developed a reliable system for investing in multi-family properties in strategic markets across the United States. Our offer to our valued Investment Partners is an opportunity to invest in income generating properties with considerable value-add prospects. With decades of real estate experience and over $100M in real estate transactions, our team understands the time and effort required to create generational wealth through real estate. Transcript: Jesse (0s): Welcome to the working capital real estate podcast. My name is Jesper galley. And on this show, we discuss all things real estate with investors and experts in a variety of industries that impact real estate. Whether you're looking at your first investment or raising your first fund, join me and let's build that portfolio one square foot at a time. Alrighty. Hope everybody is doing well. My name's Jess for galley. And this week I thought we would do something a little bit different. I was a guest on a show called CPI capital a little bit about my background in real estate from student rentals to assignments, condos multi-family and brokerage.    If you find that at all. Interesting, I think you're going to like this episode, I think we touched on a number of things and they had some great questions. Some of them admittedly completely caught me off guard, but anyways, I hope you enjoyed this episode and we'll see, on the other side,    Ava (59s): Everyone, welcome to the Canadian passive investing show. I'm your host, Ava bene Saki, and I'm joined by my cohost August. Muniez we have another great show for you today, please, please like, and subscribe as it helps us build our channel and allows us to keep bringing you great content and expert guest speakers. Our mission here at CPI is to empower investors, to create financial and time freedom through passive real estate investing. And today we are joined by Jesse for galley.    Got it. Welcome Jesse. Welcome Jesse.    Jesse (1m 34s): Hey everybody. How's it going    Ava (1m 37s): Now? Jesse, Jesse is a commercial real estate broker and investor that started with student rental properties at the age of 19 as his passion for investing grew. He started investing in single family homes and condos. Then he transitioned into multi-family apartments. So today he focuses on operating and raising capital for commercial real estate. So we believe Jesse is going to bring immense value to our audience to make strategic investments in real estate. So Jesse, let's just jump right into things.  If you could start off by telling our viewers a little bit about your background and your involvement with real estate investments, please.  Jesse (2m 13s): Yeah, no problem. And I'll, I'll try to hit that high bar there for you guys. I got started in real estate in college or university bought my first rental property, went to a university in Waterloo. It's about an hour and a half west of Toronto. You know, if there are us listeners, it's kind of Canada's Silicon valley. So a lot of good entrepreneurial spirit out there. And yeah, my first investment property was, was wa wa was Walla, was in school. I saw that I was living with a friend that his father and him went in together on the property that I was actually living with.  So w I saw myself and friends of mine paying rent to another friend and started to realize that it was a great area to invest. And I kind of had a, somewhat of a background in that. My father who's also extremely entrepreneurial and my mom was well, they had a family friend that had a number of single family investment properties. So at a really young age, I'd always ask, you know, what does Mikey do? He doesn't have a job. What is, what exactly does he do? And that kind of got ingrained to me really young, so long story short.  That's how I got into it. This is probably now I was 19, 20 years old. So we're talking about oh 8 0 9. So you don't think of oh 8 0 9 as when you're going through it as a significant time. But looking back, obviously we know now it was a, it was a pretty historic time for the economy and yeah, I mean, going back that far, what I was doing was reading Canadian real estate magazine. If you guys remember that magazine, you know, bigger pockets I think was in its infancy, there wasn't resources, there weren't resources everywhere.  And yeah, that, that was my first, first property was a $250,000 student rental property with five female tenants that I pretended were a lot younger than me, but I really was, was young and trying to try to figure it out.  August(4m 8s): Great. Yeah. I guess timing, timing is always important rate too. You know, they say luck, isn't it. Mathematical equation is when timing meets opportunity. So you jumped on it. That's great. And also, also another item is here in Canada. I mean, a lot of information and content comes over from the, from the U S where you could buy a home in Texas or Arizona or Florida for 300,000 or 250,000. And you can rent it for around $2,000 a month. So you're, you're already cash flowing from the day one, but in, in here in Canada, especially in the larger cities, Vancouver and Toronto, their rent to value ratios are very low.  So that, and the kind of also the entry level to, to get into a single family home is very difficult as well. So talk to us about, you know, early on in your career as a, you know, as you were starting in real estate investing, how did you overcome that particular hurdle to, you know, with the, with the high mark of, you know, the high bar of entry with the low rent to value ratios and also the rigid mortgage laws, our mortgage laws are much more difficult than the U S so  Jesse (5m 8s): Go over there. Yeah, it's funny. I just jumped off my podcast with a, a mortgage commercial and residential mortgage broker. And we were talking about some of the differences with Canada and the U S and, you know, we have the portability of mortgages talk to an American foreign concept for them a 30 year fixed rate. They have that foreign concept to us. So a hundred percent to your point about Toronto Vancouver, I think, you know, I say those things together in every sentence on my podcasts that we're talking about expensive markets at that time, the property, I know what just offhand, because you always remember your first property, the gross rent was approximately 2,400, so $250,000, 2,400 in gross rent.  So, you know, if you go use a 50% rule as your expense ratio, pretty decent property, if you found those types of numbers today, especially our markets you'd jump on them. So it was still relatively affordable in certain markets outside of the, like the, the downtown cores, but yeah, a hundred percent, it was something where you really had to go look for value, adds student rentals still to this day. You know, the valuations are a little bit different. Cap rates are a little bit higher.  You can, you can find those deals, but they're becoming harder and harder to find. So, you know, whether you're in New York, you're in San Francisco, you're in Vancouver, Toronto, you really need to think outside the box. You start, you need to start looking at, you know, the 18 hour cities or the cities towns hour or two hours may be more outside of your general area. But I was lucky at the time. Well, you know, nine, there were still a bunch of deals that were still in our Canadian market. And to your second point about the mortgages, I think at the time I was in the five and a half fixed percent range.  And back then, if you guys remember 5% down was still pretty doable, five, 10% down. Now, when it came to student rentals, there was only a few banks that would lend on those. So that's where you had to start, you know, getting more creative with the financing. But at the time I think it was five or 10% down. I went to my dad and asked, so I had a little bit of cash because I worked summers. I said, listen, this is an awesome investment. Do you want to, do you want to sign on this line of credit so that I can, I could purchase it, gave him the numbers.  He said, absolutely not. You know, my, my parents were divorced. So what is, what does a kid do? He goes to his mom and says, dad's not signing this. So for me, that's, that's kind of how I got my first start. And I always tell this story because I feel like people, you know, when they talk about how they got started, you, you it's always fuzzy. How did the money happen? And I just like to say that everybody you go to the resources you have. I, you know, I didn't, don't come from a very wealthy family, but they gave me every opportunity, you know, family, predominantly immigrants, very entrepreneurial.  But what that allowed me to do was she signed on the guarantee for the, for the line of credit, which added to my down payment, which allowed me to get the space. And then when the second one came around, because I continued to invest in student rentals, then I had, you know, I had a case that the next one, when I partnered on one of them with my father, or I could say, Hey, this is, this is how the business has been doing for the last year and a half or two years. So yeah, that's, that's kind of the background and  August (8m 32s): You build that track record and you were lucky enough to have parents who helped one of your parents. And he was like, finished school, finished school, then we'll dock. There you go. And you were, you were 19 years old. So yeah, I was,  Jesse(8m 48s): Yeah, just turning, just turning 20. Like I, when I put the co the offer in, I was 19, when it finally closed, I was 20.  August (8m 57s): Great, great. And if you could expand on, when you talk about student housing, is that the building or the unit or the home is zone for student housing that you can rent it on for two regular tenants kind of idea.  Jesse (9m 9s): Yeah. So it's a good question because it used to be anything that a student occupies and then what started happening in a lot of cities in the states, and in Canada, you would have either municipalities or cities mandate that you have a student license, you know, we're all big fans of the government. And it was basically, you know, a, a tax that you had to pay to have it licensed. Now, I'm not saying that there isn't good logic for it. There would be, you know, fire code, additional things you would have to do to meet that standard.  But it was also kind of like a, you know, a, a taxi medallion system where, you know, they only would, in, in this particular case, they would only give so many of the moats. So yeah, that, that's how they were kind of categorized in Waterloo. And I know another areas in Ottawa, we have, I still have a couple student rental properties where we're towns are, are kind of talking about implementing that type of thing, but not all towns do. And yeah, so that, that's how it, you know, they'd be categorized as student rentals, some were above board and some people were doing just, you know, without the license.  August (10m 13s): Got it. That makes sense. Just getting back to your point, as far as making strategic investments, and you have to find the kind of diamonds in the rough for it to make sense here in Canada, in Vancouver and Toronto, there are deals, but they're, they're, you know, hard to come by. It's not a scalable business model. It's not somebody, you know, in the U S somebody living in Texas making a hundred thousand dollars a year and they can buy a home for 300,000 and they'd be cash flowing from day one. And, you know, if they do some small renovation and even keep the property, they can, they can, then in a few years, just repeat the same process, buy another property and continue to grow their portfolio.  It's very difficult business model to, to do here. And especially doing a part time, having a, you know, a, a, you know, a job or a profession, and then doing real estate on the, on the, on, on a part-time basis to then find those deals, to be able to be an active investor. So that's an great conversation here.  Ava (11m 6s): So we've, we've we, we learned about what started you in single family. Now, I'm, I'm curious what made you fall in love with multifamily? And when did you kind of start getting into multiple  August (11m 16s): Fell in love with it? Maybe he just likes we're  Jesse (11m 19s): We're we're madly in love. Well,  Jesse (11m 22s): What happened was w so I finished university over that time period. I, I purchased, I believe it was for single family. So these, but these were kind of spread out there. One was in Oshawa. So if you know, Ontario Schwann, Waterloo, they're complete opposite ends of Toronto. And what happened started happening is, and I'm sure you guys were aware of Vancouver was similar where pre-construction condos became a big thing, and this was 20 10, 20 11. I started to purchase those. And what, you know, a lot of people call wholesaling now, or just assigning the contracts.  I did a few times. So w what I did was I kind of kept going down the student rental path. I appreciated a decent amount on a lot of these properties, and then sold them pretty much, not all at the same time, but pretty strategically that I wanted to sell these and have a nest egg to move into the commercial space. It coincided with my job, actually moving from working with the job that I got right out of school to actually a friend of mine kept saying, listen, you'd love this real estate stuff.  You know, what are you doing in your current job? You should be in, in commercial real estate. And I finally got a job in commercial real estate for Avison young as a commercial broker. I happen to work in office leasing and investment sales, but it was kind of through that, where you start really opening your eyes to see what people are doing in different areas. You know, my partner, he also works for the company, but he also is an investor in the multi-family space. Multi-family I think the reason I gravitated towards that is it's just more accessible for the smaller investors that when they get their start, if you're going down retail office, industrial, you know, one, one or two tenants, you could really have large vacancy.  You need a lot of cash for 10 and allowances, tenant inducements. And then the other thing is in Canada. And I believe it's, it's similar in the states, whether it's Fannie Mae, Freddie Mac in the us, or it's CMHC in Canada, there, there are financing products that are more geared to apartments because it's still considered residential, even though it's five units and larger, which lender looks at that as commercial. So yeah. Accessibility for, for lending and yeah, that's, that's how I made the transition.  And we've, yeah, we've kind of focused now, just exclusively on building up the multi-family portfolio,  August(13m 44s): Right? So not only your focus as, as investing changed to multi-family commercial real estate, you, you actually switched your profession to also be involved in the commercial space as a broker. Funny enough, Ava and I were looking at a private equity firm and their principles, and just reading about their bio is, I mean, notice every one of the principals had commercial broker on the bottom of their title, even though some of them, one of them had a PhD, but he still had a commercial broker at the bottom  Jesse (14m 10s): Of their bio. It's funny, it's funny. They there's a lot of people in our industry and NAIOP is a great organization. If you're interested, especially in Canada, in commercial real estate or north America, that's, it covers all areas. But so many of the people that have started their own firms that are CEOs of brokerages or workflow, you know, workplace strategy, it's funny how further back in their career. A lot of times they were brokers or, you know, leasing specialists and really seeing real estate from the ground up.  And I think it's a good foundation as investors, or if you want to have a career in real estate. Yeah,  Ava (14m 48s): Definitely. Great. You got your license. I had my license.  Speaker 3 (14m 52s): Yeah. I couldn't wait to get rid of mine for 10 years.  August(14m 59s): So now I want to talk to you about, let me see, I had a question here for you. Oh yeah. I want to talk to you about, you know, we, we w w w in our research, we are in the space we're in, in Canada and in the real estate of real estate, private equity and, and especially thought leaders in this space who put out content, obviously you came up or you came on on our list. I mean, notice that you are a thought leader in this space. Talk to us about your connection with a bigger pockets and how that came about. Especially one of my biggest complaints with bigger pockets is that most of their content and information is, is a director is for Americans.  And a lot of people do read that information. And now have I have wrong information or information that doesn't make sense. They, they believe that 10 31 exchange exists here in Canada, or that they could, you know, part-time be real estate investors and have 20 single family homes or, or, or other also other compliance verbiage that's that's used in the us, which that doesn't mean the same thing on this at our border, and means something totally different. Something like an offering memorandum is a document provided by a broker to someone looking to purchase a commercial real estate, or an offering memorandum here in Canada is a, is a legal document as security emerges exemption that's used.  And it's a legal document. So talk to us about your connection with bigger pockets and how they came about, and what do you currently do with that group?  Jesse (16m 24s): Yeah, for sure. I think it started from, well, I was on the podcast, the BiggerPockets podcast as a guest years ago. I think that was what started the relationship. I, I really, I don't remember exactly how that relationship started, but it did then. And what it ended up happening is we, we continued communication. Obviously I used a bigger pockets as a resource. And just as a side note for Canadians that are on bigger pockets, even if you have a free account, you can go and put a keyword alerts.  And almost always, I have one keyword alert that is Canada Canadian, us Canada. So like you do get chats that are started specifically about CA Canadian investments. You're going to be pulled into those, into those strings, which, or forums, which is great the way I started doing videos for them. I think Brandon and I, we were talking, or I, I had reached out to him a little while after the podcast. And I had said, you don't, you guys don't seem to have a lot of commercial content, whether that's, you know, industrial retail office, larger apartment buildings, it seems to be focused primarily on single family and, and apartments.    And I said, what if would you guys be open to me doing videos? And he's like, I guess at the time, they're like, yeah, absolutely. It's, we're, we're missing that piece. So yeah, for a couple of years, I was doing videos on a commercial commercial real estate. That's commercial loans, private equity. You're absolutely right though. When you say that, you know, there's that us Canadian gap and a hundred percent it's, you know, you have American her Canadians thinking that they should buy us real estate and put it in an LLC. Okay.  Canada, that doesn't recognize an LLC. You know, you have a certain things, like you're saying what the offering memorandum, you keep hearing, they're raising money for 5 0 6 C offerings that doesn't exist here. So there's all these little intricacies that we need to focus on that when we, when we hear about this type of investment in the states, really need to figure out what that equivalent is up here. And that's what I think we were trying to do to a certain extent there. But like I said, ultimately, as a Canadian, there's definitely Canadians on the, on the forums there, you just kind of have to have to search for it.  But yeah, it's a, it's a really good point.  August (18m 40s): Great, awesome. Talk to us a bit also about your, your own platform. So aside from working with bigger pockets, I believe you have your own YouTube show and podcasts. Talk to us about that in the process and how you came about, you know, starting your show and how it was, how is it going? Yeah,  Jesse(18m 58s): No, it's going great. It's, it's a lot more work as you guys know, then, then, you know, you really realize when you go in, I was just a friend of mine just sent me a stat or a couple stats about podcasts. And it was, I can't remember exactly, but, you know, you know, something like 3% of people go pass episode three, you know, 50%, you know, whatever it is, it's just the consistency. I'm definitely more active on working capital. That's my podcasts. It's working capital, the real estate podcasts. You can get that anywhere, iTunes, Spotify, and the YouTube channel.    I just started putting out like a lot of people, the questions you get asked again, and again, and again, a lot of times it's just easier to make a video, send it out and say, you know, this, this answers it. I think that being on the bigger pockets, realizing that, you know, like when you go on their channel, it's like all of a sudden you have, you know, 70,000 views on something and you can't manage comments like that. So I think for me, it was just like, I didn't realize there was that many people out there that wanted this content. So I try to put stuff up on YouTube as, as much as I can, but really the focus for, for myself is more on the podcast side.    And then through there, you know, people can reach out to me, you know, hear me on the show. And if it's about investing in the future, investing in other investments that we're doing that we're raising capital for. That's where I would say the platform is, but it hasn't been formalized in, in a way where, you know, it's, it's my day job and that's, what's challenging about it. Right. You're, I'm still in brokerage and I don't think I'll ever leave brokerage completely, but yeah, that's, that's kind of where I'm at right now.    August (20m 35s): Yeah. Being a broker is like, you know, the bat, the bat sign put up in the sky when they call it comes in. You've got to go. So yeah, it's definitely a full-time    Speaker 3 (20m 44s): Gig. Yeah. Great.    August (20m 46s): Just to touch on podcast a bit more, what is the podcast mission statement? So what, what problem are you solving? What message are you getting across and what is the kind of the, the final call to action or, you know, the, the, the benefits it has not only for obviously your, your listeners, but also for yourself.    Jesse (21m 4s): Yeah. What I wanted to do is have an educational, real estate investing podcast that where we have guests on, we have them from a range of backgrounds all centered around real estate. So, you know, whether that's a cross border lawyer, whether that's a mortgage broker, whether that's talking to people that are investing in self storage, I wanted to get kind of a round picture of what real estate is and the different niches, or as my podcast guests say, if they're American niches, that drives me crazy, but the different niches in our industry. And through that, I'm what I hope to do too, is when I have people on the show and you touched on it earlier as a Canadian, even though half of the listeners are American, I try every time I can, where somebody is like, well, an FHA loan, and then, okay, well, let's just clarify from the Canadian point of view, it's this.    Or, you know, if they say something like a 30 year fixed mortgage at 3%, and I say, well, in Canada, you can do a CMHC mortgage at 1.6. They're like, that's crazy you at 1.6, because a lot of times you hear, they don't believe that our cap rates are 2.9, 3% in some areas like you're in Vancouver and guarantee some of those office buildings are sub three and they're like, well, our loans are three. It's like, no, no, no, no. Your loans are three. Are our loans are not even though it's still crazy low. So there's only all these little like variation.    So just a long, long winded way to say. What I try to do with the podcast is try to be a north American podcast where I can have Canadians and, and Americans listen to the show and, and feel that they're both getting talked to.    August(22m 36s): Great. Great. So now let's switch the conversation here. Emma has a few questions for you, but let's switch the conversation back to being a real estate investor. As we all know, eventually your real estate investors run out of their own money because they've already deployed it. Or they're looking for bigger projects and a time comes to raise private equity. Where are you at in your, in, in your business currently, are you at that stage that you're, you're raising capital and, and talk to us how that all came about and we can go from there.    Jesse (23m 6s): Yeah. So this year, or I guess the end of last year starting of this year is when I first started to raise capital for real estate. It's, it's kind of a scary thing, which I think is a good thing. If, if you are a fiduciary to somebody else and you're managing somebody else's money, I think you should party. You should be a little scared. I think that's natural that you should have a fear of making sure that you're, you're doing the right thing for your investors. So that coincided with a lot of the podcasts I listened to.    And again, the guests that I've had on my show where, you know, you get connected to masterminds where they are teaching, raising capital or fund to fund model, stuff like that. And again, it kind of goes back to your point of the offering memorandum where like, you know, we sometimes call it an information memorandum. That's more of a brokerage thing than I think a us thing. But yeah, the offering memorandum in Canada, you're, you're talking about legal documents. And the reason I bring that up is the mastermind that I was in was a us centric mastermind for raising capital.    So even there it's like, unless you're investing in the U S it's really challenging to justify what you're spending on that, a mastermind, depending on the cost. But anyways, that got me into the mindset of it, like buying your first property, once you do it once you're like, oh, that I can, I can do that. And that's really what it, what it was for us. Once we started raising capital. So this was the first investment raised a million and a half of equity.    So it's not a huge amount, but it was the first time we ever raised capital it, me and my partner. And, you know, the thing is, there's just, you go through these different cycles while you're raising up. Are we going to have enough? Okay, we're good. No, I don't think we're good. And then it got to the point where we're like, you know what, after it's all said and done, you have subscription agreement signed. You're like, I think if, if I was forced to, I think I could do three, I think it could do five. And I think that's the natural progression when you get used to something and you see that it's, it's achievable.    That's    Ava (25m 10s): Fantastic. And Jesse, I'm curious, what structure do you use to raise private capital?    Jesse (25m 15s): So we do a pretty standard limited partnership agreement. So general partner, limited partner with the caveat of having a asset management company, as part of basically the administration that kind of handles everything. So for those that don't know the, you know, the limited partners are all your investors. They have limited liability. This is not legal advice, but they have limited liability in these investments. The general partner in Canada partnership can not own a real asset that they can't own a property.    So you need to have sometimes a numbered company or a GP. The general partner as a corporation oftentimes owns the property has title, but the limited partner has a beneficial ownership of the property. And then from there, Ava, we do a very simple split where, you know, you have a certain threshold of preferred return that goes to your limited partners. So return of capital first, a preference turn of a certain percentage. Then after that a profit split between the general partners and the, and the limited partners, okay.    August (26m 22s): Maybe you can kind of talk to us more about the deal that you had. So for example, here at CPI, our business model is the multifamily value add and because of their, their higher rental value value ratios that exist in the us on a 70, 30 LTV, you know, we're, we're able to, from the rents we collect, we're able to pay our mortgage payment, pay taxes and fees, third-party property manager, and still have a surplus to pay our investors. Those preferred returns you talk of from day one, because the deals we look at are usually 90% occupied.    So they're, they're well above the mark. So now, how do you go about your deals? Are, are, are your deals ground up development? Is it a value add project? Is it kind of A-class talk to us or what kind of deals you guys work on and how are you able to, is there a return given to investors from day one or is there a kind of a capital event where the project has to go through a certain steps before there is any kind of cashflow coming back to the investor?    Jesse (27m 21s): Yeah. So for us, I'm constantly looking for off market deals, you know, as a broker, you know, first thing we think is we're not bidding on deals. So for me, I was actually land registry looking for properties off market calling, Hey, Jesse, for galley. Listen, I want to put an offer in, on your property when you consider one. So what D constantly outreaching for off market deals happen to find an off market deal? A gentleman owned the property for a number of years. I think it was kind of retirement time for them there. They were, you know, ready to sell.    So for me, this just happened to be a class deal. I wasn't searching for an A-class deal, but it was in probably one of the most expensive areas in Canada, in forest hill and Toronto. It just so happened that when we took a look at these rents, we were, we just saw that it was probably at 60% of what market is. So initially when we went into it, we, what we were going to do. And a lot of our clients do this, where they do what they call condo finishes two older apartments.    So you're putting a dishwasher in the apartment in suite laundry and what our initial thoughts were, were to go in, do $75,000 per unit, really higher end upgrades to achieve higher end rents. Now COVID happens. And all of a sudden, Y you know, you have to be careful about trying to just do a class when the market, you know, might not be able to sustain it. So, for us, what we did was we kind of pivoted and decided to do, you know, instead of a $75,000 upgrade, maybe a 40, 45 more conservative rents, and then kind of, you know, turn over three, four suites within a shorter time period.    So the structure of the deal ultimately was it wasn't, it wasn't a vanilla deal. It was a bridge loan for two years, stabilize the asset, do the renovations, renovate the L renovate a lease at these higher rates, then switch to a conventional, or, you know, CMHC loan switch to the L to that loan once you've achieved that rent. So that, that basically the mortgage takeout takes out your bridge loan. And now you have a stabilized income.    And to answer your last question, in terms of the capital event, this, this deal would be like a development deal. And if anybody has seen, you know, limited partnership agreements, when it comes to the development deals, you get your preferred return. And just as an aside, the preferred is not a guaranteed return. It's a preferred return. And absolutely you try to achieve that, but in a development deal, you know, there's no income. So what happens is that say 7% preferred return a cruise. So your one seven year, two 14, you know, some people compound it.    We don't, it's just simple accrual. And then when there is a capital event, say the refinance, then we decide then do we pay investors all back their initial cash, keep them in the deal, or do we sell a property? Has it gained enough that, you know, it looks appealing to sell and pivot or, or buy another asset so that, yeah, we, we, looking back, I would have had a lot, a lot less stress if we picked a more vanilla investment, but that's, that's what we, what we got our hands on.    August (30m 33s): Great. Oh, how many units was this project?    Jesse(30m 35s): So this one was, this one was seven units, but for anybody that's not in a major market, we're talking about 500,000 plus a unit th the, some that have sold on the street or 700,000 a unit. So this is not, you know, you're not in Boise, Idaho, the first investment, sorry, apartment building we bought was actually west of Toronto and Hamilton 11 unit. And it was a third of the price. So it's just a matter of, you can find expense, more expensive assets, but there definitely has to be a value play there because they're just too expensive to buy.    If they're, if they're already stabilized and at full rent.    Ava (31m 17s): Awesome. And the whole time, Jesse, what's the whole time that you guys were predicting    Jesse(31m 21s): For the, for this one that we're purchasing. So this one, what we have is that to your kind of timeframe, to do the renovations. And then for us, really, we talked to investors, the fund, the sort of the partnership is open for you no longer than that. But I personally, if, if things are where we think they will be in two years in terms of where we want to get the rents, I would love to refinance it, get everybody their capital back and stay in the deal together. And then down the road, because of where it's positioned with a lot of over a billion dollar of Provigil funds in transit.    I think we could add another story to it longer, you know, in the long run. So yeah, we have a few options, but I, the reason I bring that up is I hate seeing these investments where somebody says, like paying out their LPs and then buying them out. It's like, you're the reason they got this asset. You can pay them out and then they're not in the deal. Yeah.    Ava (32m 17s): Options are key. That's fantastic. Now maybe we can discuss your nurturing process for your investors as it's obviously a very important component of, of syndicated investments. So maybe you can please tell us how you nurture your investors and get that know like, and trust and keep that know like, and trust going.    Jesse (32m 36s): Yeah, for sure. I, I can't remember. It was actually a guy in the west end. I think Saskatoon, I had on my podcast and he said, this is very simple. He was, he's like, listen, go on your phone. If you scroll all the way down, if you have an iPhone and you're a contact scroll all the way down to the bottom, you'll see how many contacts you have. It's actually crazy when you're like, how did I accumulate, you know, whatever thousand 700, whatever contacts you can upload those to your computer as a spreadsheet. And you could run through those and really look at who's somebody that haven't had contact with that I could reach out to not to sell them anything.    But as a touch point saying, listen, you know, how are you doing? It's been a while, just a general email. So he had like a three-step, you know, general email, a discussion and just not being salesy. And eventually basically telling people, listen, like, you know what I do in real estate, these are the type of investments that I buy. If this is something that you'd be interested at all, when we have one of these under contract or we're purchasing one, let me know if you'd want, want me to share it? And if you don't just let me know as well.    And nine times out of 10 people don't say, no, they don't say like, no, no, don't tell me. And you know, you be somewhat strategic about the people that you're, you're reaching out to. And then I think what people really need to do, you're in so many more networks than you think you are for me. I did my masters at university of Toronto and just reaching out, literally getting the class list for my year and go and reaching out to all of them. Because, you know, if they, if they did that in school, they're probably, you know, doing something that, you know, might be a little bit different.    They they've made a career change maybe later in life. So you have access where I had access to a lot of people that were like, yeah, a hundred percent sign me up. And some of the people that are in the subscription that, that are LPs were from that. So, you know, I've had people on my podcast that were in law enforcement and they left the force and then they, you know, they had their first indication with 20 cops. So I think you got to look at the networks that you're in and, and don't be afraid to tell people what, they're, what you're doing. Like you, you, you two are doing here, you know, people know when they talked to you August and Ava, like yeah, they're, they're in real estate.    So I think being seen as is important, and I know it's not easy for everybody. We're not all extroverts, but it really is an important part. If you want to attract capital and, you know, that's the path you want to take.    August (34m 58s): Great. Awesome. And I'm sure your shows and your connection to a bigger pot pockets is also a great cultivation process for, for bringing awareness to you and, and investors to, to your services, but maybe briefly touch on your nurturing process when the investors do connect with you, if it's from your own list or from, from your marketing campaigns or from your thought leadership platform, as they come into your database, how do you keep in touch with them? Do you know if it's through newsletters or other content that you send to them? So eventually when you do have a deal, because as, as us being in the syndication business, we're not a fund, we're not continuously buying assets and continuously raising capital, we look for a great deals and then we present it to our investors, to, to us very briefly about your nurturing process when for your leads or your contacts.    Yeah,    Jesse (35m 43s): Absolutely. I think for me, part of it is, you know, when you go to working capital podcasts.com and people will subscribe to the podcast, that'll be part of, you know, me reaching out to people and connecting and nurturing through there when it comes to people that I've, I've reached out to that say, didn't sign up for the last syndication, just touch points with them, whether, you know, constant contact or MailChimp keeping kind of abreast of keeping them abreast of what you're doing. And really, I haven't, I haven't formalized it in like to a T for me, it's just been, you know, the list of people that I have that are in my database, on, you know, through my website where we capture all the emails through the, the list that I have when I reach out to people.    And yeah, it's, it's really, it's really like that right now. If we move to something more formalized as we, as we continue, you know, maybe that, that will be the path. Ideally, I'd like to get to a point where we're going to have committed capital rather than syndication where you're chasing the deal, chasing the clock, whereas where you can call capital and you have the fun there. Yes,    Ava (36m 47s): It's cool. Cause you probably have a long list of people who are watching you on the sideline watching you kind of do your first deal and then your next one. And eventually a lot of syndicators say five years down the road, they've been watching us and boom, they just gave me $2 million. Well, I had a buddy    Jesse (37m 0s): Of mine and like really good buddy that I did, that it was in my MBA and he's like, he opted out of the deal and he was just, you know, you know, you get a guy constantly asking you questions like, and then he's like, ah, so, so did that happen? I'm like, yeah, it happened. And he's like, oh, okay. I'll like, I'll, I'll go on the next one. I'm like I told you, man. So yeah. I mean, you just keep in touch and you know yeah, yeah. And it seems    August (37m 20s): Your process is much more up close and personal and hands-on, that's always the best way to go about when companies get bigger. You never even get the CEO on a call with your cases is very kind of up close and personal and that's great. That's great. Awesome. All right.    Ava (37m 33s): Now, Jesse, let's time to have some fun. We're going to start the next segment of our show. So we like to call this the 10 championship rounds to financial freedom. So please just tell us the first thing that comes to your mind and I'm going to get started.    Speaker 3 (37m 51s): All right. I am. I'm set. All    Ava (37m 53s): Right. So who was the most influential person in your life?    August (37m 59s): Cool.    Jesse (38m 1s): Oh, I'm going to get one of the mad probably my father.    August (38m 4s): He didn't give you that money, man. He's, you're attracted to the hard to get.    Ava (38m 11s): What is the number one book you recommend?    Jesse (38m 14s): Oh man. So many, but all I just say, start with no gym camp. Okay.    Ava (38m 20s): If you had the opportunity to travel back in time, what advice would you give your younger self start    Jesse (38m 29s): Early start, start right away. You    August (38m 31s): Started in 19.    Jesse (38m 33s): I think just in general with other things like anything in life that you go, I'll do this. Oftentimes you don't do so. Just, just jump in. If, if you know you, you will, you will regret not doing it. You know, that'll    August (38m 45s): Be the heavier regret when totally    Ava (38m 49s): All right. What, what's the best investment you've ever made    Jesse (38m 55s): In my education.    Ava (38m 57s): What's the worst investment you've ever made. Let me think your    Jesse (39m 5s): Worst investment I've ever made. One, one student rental property. It's tough to call them the worst because you learn from those. But very, a lot of, a lot of mistakes made on that, that, you know, took, took a while to, to, you know, fix and yeah.    Ava (39m 21s): All right. How much would you need in the bank to retire today? What's your number?    Jesse (39m 28s): Nothing. I, I love being active and working and I don't, I don't find what I do, you know, a job job. So    Ava (39m 38s): If you could have dinner with someone dead or alive, who would it be?    Jesse (39m 43s): Well, dad's more fun and morbid. Probably Milton Friedman. I've the economist. I've, I've always found his, his writing's really good capitalism, freed and freedom free to choose. Yeah.    Ava (39m 56s): Awesome. If you weren't doing what you're doing today, what would you be doing now?    Jesse (40m 1s): That's a good question. Probably law. Okay.    Ava (40m 6s): Book smarts or street smarts.    Jesse (40m 12s): After all my education, I always still say street smarts.    Ava (40m 17s): Okay. If you had a million dollars cash and you had to make one investment today, what would it be? I would put it    Jesse (40m 27s): In a fund as the GPS Capitol to show our skin in the game and you know, whatever we can multiply off that with, with investors. Awesome.    Ava (40m 38s): That's a great answer. Awesome. That's great. Those    Jesse (40m 41s): Are so yeah, you don't get asked those every day. Yeah. There    Ava (40m 44s): You go. Kind of puts you on the spot and it's fun footings, you know, first thing that comes to mind occasional    August (40m 50s): As well, right? It helps others kind of think about these questions and kind of helps them with the process. Hey Jay, Jesse, we really appreciate your time. Thank you for thinking. We know you're super busy. We really appreciate taking the time coming and speaking to us, definitely add a lot of value to our viewers and eventually our listeners listeners when we change this show to a podcast and,    Ava (41m 9s): And yeah, Jesse, if you just want to take a quick moment to tell everybody what, the best way that they can reach you, please.    Jesse (41m 15s): Yeah, for sure. I mean, aside from a Google search, Jesse, for galley working, working capital podcast.com, you can go there if you want to subscribe to, to get the show or Spotify, iTunes and yeah. Reach out to me there I'm as a broker, I'm not hard to find. So that's yeah.    Ava (41m 35s): Johnson, Jesse. Thanks a lot for coming today. Thanks so much.    Jesse (41m 47s): Thank you so much for listening to working capital the real estate podcast. I'm your host, Jesse, for galley. If you liked the episode, head on to iTunes and leave us a five star review and share on social media, it really helps us out. If you have any questions, feel free to reach out to me on Instagram, Jesse for galley, F R a G a L E, have a good one. Take care. 

Currently, there are over 20 different generic versions of the world's first safe “smart tab” - modafinil that is available for sale worldwide. Most of them are very similar to the original modafinil trade name version, Provigil® - by Cephalon. Modafresh is one of the newest additions to the generic modafinil available today in the global market. Most modafinil users are familiar with Provigil®. However, Modafresh is almost not known by new users when it comes to generic modafinil brands. Even large nootropic blogs, including Drugs.com & WebMD, don't have a post or any publication on Modafresh online. This guide https://modafinil.org/modafresh/ discusses what you should know about Modafresh, its benefits, tips about its manufacturer & reputation, and much helpful information about buying safe Modafresh pills. Timestamp 00:57 What Is Modafresh? 01:43 The Effect Profile of Modafresh 02:28 The Benefits of Modafresh 03:20 The Problem with Buying Modafinil 04:03 Who Makes Modafresh? Are They Reputable? 05:17 The Difference Between Private & Public Drug Companies 06:17 The Downsides of Private Companies 06:36 1. They Often Have Poor Transparency 07:28 2. They Lack Vested Interest from the Public 07:54 3. They Tend to Be Much Smaller than Publicly Held Companies 08:20 4. Less Regulation Involved with Manufacturing 09:01 What This Means for Modafinil Users 09:35 Modafresh Alternatives 10:26 Final Thoughts on Modafresh

Drs Kurt DeVine & Heather Bell continue the series on drugs felt to be safe…. But are not necessarily! In Episode #10 of “Safe Drugs- or Not” we discuss modafinil aka Provigil- a medication approved primarily for narcolepsy. Sneak peek- very interesting, but rare, side effect! To learn more about the doctors as well as keep up with current happenings follow us on twitter: @echocsct and Facebook: @theaddictionconnectionhk

Drs Kurt DeVine & Heather Bell continue the series on drugs felt to be safe…. But are not necessarily! In Episode #10 of “Safe Drugs- or Not” we discuss modafinil aka Provigil- a medication approved primarily for narcolepsy. Sneak peek- very interesting, but rare, side effect! To learn more about the doctors as well as keep up with current happenings follow us on twitter: @echocsct and Facebook: @theaddictionconnectionhk

We used to have a name for sufferers of ADHD. We called them boys.AnonymousBackground: For opioids, the deaths, addiction, and social destruction are the drug industry's fault—there is no controversy. There is now an anemic effort to fine and sometimes imprison a handful of people who were partly responsible for the death of more individuals than most wars. There is no consensus, however, for the closely related situation of amphetamines and similar stimulants, possibly because there are only 10,000 US deaths a year. Doctors who are in the pockets of manufacturers still proclaim with straight faces that amphetamine-class prescriptions are worlds apart from the same drugs used for abuse. They say that we are under-medicating despite close to universal usage. Physicians promote prescription stimulants for attention deficit hyperactivity disorder (ADHD) and other syndromes. Classroom misbehavior gets kids a quick prescription these days. Fidgeting, squirming, interrupting, forgetting, and being disorganized are the symptoms. For adults, the criteria are inattention, hyperactivity, impulsivity, and other similar issues. This has made ten percent of our children and many adults “legitimate” drug candidates. American psychiatrists now treat ADHD with at least fifty prescription medications (listed on drugs.com). These include antidepressants, stimulants, and even anti-virals. Most are FDA Schedule II, the category that includes cocaine, Demerol, and other drugs considered the most hazardous. (Schedule I drugs have no accepted medical use.) Antidepressants and milder Schedule IV stimulants such as Provigil are also used.LINKS TO LEARN MORE:Listen to another podcast about my whole book Butchered by Healthcare at: https://www.buzzsprout.com/1300429/6572743I have an author website RobertYohoAuthor.com. Go to the book's web page if you want to order it or read the over 50 five-star reviews: https://www.amazon.com/Butchered-Healthcare-Doctors-Corrupt-Government-ebook/dp/B08FVMK5GY/ref=sr_1_1?dchild=1&keywords=robert+yoho&qid Please review it here: Amazon.com/review/create-review?&asin=B08FVMK5GY. I appreciate you for taking the time, and I will read your review. This is a big favor for me—thanks… NEWLY AVAILABLE FOR BETA READING: The Secret Story of Hormones: Miraculous Treatments for Fatigue, Cancer, Heart Disease, Depression, Alzheimer's, Impotence, and Diabetes—and How They Were Stolen From UsDownload your copy at https://dl.bookfunnel.com/pffhxv9lt6  Please give feedback at yoho.robert@gmail.com. Here is a patient video from the cover: https://m.youtube.com/watch?v=mWTi-CtTV1ISupport the show (https://paypal.me/dryohoauthor?locale.x=en_US)

About 1 in 50 US adults use stimulants like amphetamines (Adderall), methylphenidate (Ritalin), and modafinil (Provigil) without a prescription, and 80% of them take the drugs to enhance cognition, not to get high. The ethics of all this are vexing, but putting that aside, how well does the practice work? And how does it compare to drug that most of us ingest everyday: Caffeine. [Study Link] Published On: 12/2/2020 Duration: 4 minutes, 47 seconds Got feedback? Take the podcast survey.  

There are various ways of how to administer medications. Some people like tablet forms, others prefer injectable while several of them would feel comfortable dissolving their meds in their mouths. Modafil MD is the best drug for people having difficulty swallowing meds. This unique & cheap generic version of modafinil (Provigil®) is what you might want. This pill comes with a fresh spearmint flavor & a special coating. You don't have to swallow. In the tongue, the medicine is swiftly absorbed through the mouth at a faster rate compared to a tablet. This type of medication has more intense effects compared to any other version of modafinil pills on the market. With that said, the big question is: does sublingual modafinil work? How effective is its mode of absorption? Well, this guide https://modafinil.org/modafil-md/ to Modafil MD pill by INTAS Pharma, covers what you need to know in detail. It covers what drug users say about its taste, benefits, and what makes it different from other modafinil versions. In the end, bonus for you: good reviews of the best modafinil vendors where you can source quality nootropics for yourself as well as Modafil MD 200 mg tablet. Timestamp 00:49 What Is Modafil MD? 01:30 What Are the Benefits of Modafil MD? 02:13 Are There Side Effects to Modafil MD? 02:48 What Makes Modafil MD Different From Other Modafinil Options? 03:22 What Are the Benefits of Sublingual Medications? 04:31 How Sublingual Drug Absorption Works 05:51 Does Sublingual Modafinil Work? 06:14 Some Caveats with Modafil MD Sublingual Absorption 06:52 How to Take Modafil MD Sublingually 07:28 Modafil MD Versus Modalert and Modvigil 09:09 Cost of Modafil MD 09:52 Final Thoughts on Modafil MD

Terri Cheney was a successful entertainment lawyer who represented some of the biggest names in the business, like Michael Jackson and Quincy Jones. All the while, she hid her mental illness and the slash marks on her wrist from a suicide attempt. She bravely started writing about her experience living with bipolar disorder after several horrific suicide attempts, encounters with the law, broken relationships and, eventually, a stint in a mental hospital and several rounds of electroshock therapy. The writing led to her first memoir, Manic, which went on to become a bestseller and the basis of an episode of Netflix's Modern Love where Anne Hathaway did a phenomenal job capturing Terri’s mania and depression.   In Terri’s new book, Modern Madness- An Owner’s Manual, she combines clinical research with her own lived experience- stories like her manic highs accompanied by extreme drinking, driving, and dating. Her new book brilliantly bridges the gap between the one-size-fits-all approach of modern medicine and makes it relatable and valuable for everyone. Those dealing with mental health issues and their family and friends who are often left to pick up the pieces will undoubtedly appreciate her humor and her insight.   Terri lives in Los Angeles, teaches personal essay writing workshops, and keeps up her blog, The Bipolar Lens for Psychology Today.    SHOW NOTE LINKS:   Terri Cheney’s “Modern Madness”   Terri Cheney’s “Manic”   Terri Cheney’s “Dark Side of Innocence”   Terri Cheney’s Blog, “The Bipolar Lens” on Psychology Today   Fourteen Insightful Memoirs about Mental Illness and Addiction Rachel interviews her mom, Laurie Kallen Schwent    CONNECT WITH US! *Dear Family, Podcast Page *Write Now Rachel Website *Rachel's Blog @Medium *Rachel’s Twitter *Facebook *Instagram   PLEASE JOIN: *Dear Family Members, the Private Facebook Group     WAYS TO HELP THE PODCAST: *PLEASE Leave a 5-Star Review and ***Listen and Subscribe via iTunes!!!  ***Listen and Subscribe via Stitcher!!! ***Listen and Subscribe via Spotify!!!   Thank you! Your support means the world to me. Wishing you love, happiness, and good mental health always.

bengreenfieldfitness.com/modafinil   Modafinil (also known as "Provigil").       It's the darling of the smart drug industry, and has been for quite some time.     With in the past 10 years, it is reported to have few to no side effects, to not be addictive and to not be excessively stimulating.     It's used by notable figures like Joe Rogan, Ray Kurzweil, Barack Obama, Hilary Clinton, Tim Ferriss and many others.     It's the entire inspiration behind the smart drug movie Limitless with Bradley Cooper.     It may .     Laboratory studies have even shown that it may have .     Modafinil is also of a .     Acute modafinil ingestion significantly .     So what could go wrong? Is this stuff too good to be true? Surely there must be some dark biological side of this supposed super smart drug. In today's podcast, I host a guest who knows more about the science of modafinil than anyone I'm aware of, and who, conveniently, happens to live just a few miles from my house: Dr. Jonathan Wisor.       During our discussion, you'll discover: -How Jonathan became interested in sleep and neuroscience...8:05         -What is Modafinil, exactly?...13:40         -How various neurotransmitters respond to modafinil...19:30         -Antioxidant and neuroprotective effects of modafinil...23:20         -How modafinil use can go wrong...31:15           -Whether or not genetics determine a response to modafinil...47:05         -How Modafinil affects sleep cycles...49:50         -How long does modafinil stay in the bloodstream after taking it...54:15       -Effects of combining modafinil w/ alcohol and drugs...57:55     -Why Jonathan has never used modafinil personally...1:05:50         Episode sponsors: Kion Creatine, Beekeeper's Naturals, Thrive Market, Seed   bengreenfieldfitness.com/modafinil

We live in an era of “smart pills” and I prefer generics. Modafinil comes in the form of a generics and brand-name version (Provigil®). Brand name versus generic products is common in every industry — from pharmaceuticals to clothing. Why is modafinil so popular? “Smart drug” enthusiasts are always looking for effective and safer ways to be sharper and more productive in regards to better ways to hack the brain. In an earlier time, the most known cognitive enhancement options used to boost the brain function were dietary or nutritional supplements, but, today, modafinil is revolutionizing the pharmaceutical industry with a broad list of generic potent meds dubbed as “smart drugs” that has a smarter way of enhancing brain function and promoting wakefulness. In this https://modafinil.org/generic-modafinil-vs-provigil/ article, we discuss – what are generic meds and what are brand-name medicines, how do generic medicines compare to brand name meds, why some types of medications cost so much money, why most people prefer generic “smart pill” (modafinil nootropic) to brand-name medication, and the most important factors the pharmaceutical pricing group considers. This guide further explores why the price points are so dissimilar between generic modafinil vs Provigil, the listicle of generic modafinil products, and where to find genuine cheap modafinil from legit and most reliable online “smart pill” vendor. Timestamp: 01:01 Modafinil: Study Drug Of The Decade 02:03 Why Is Modafinil So Popular? 03:30 Finding Cheap Modafinil Online 04:44 Generic vs. Brand Name Medications 05:04 What are Generic Drugs? 05:37 What are Brand Name Drugs? 06:03 Why Medications Cost so Much Money 07:47 Pricing Medications After Research is Completed 10:48 How This Applies to Modafinil 11:24 Enter Generic Medications 12:18 Generic Medication Quality 12:55 List of Generic Modafinil Products 13:22 How do Generic Drugs Compare to Brand Name Drugs? 14:09 Why I Prefer Generic Modafinil

CC* is a Registered Nurse and has a lifetime of expertise and wisdom from both sides of the health care dynamic - as a patient harmed by medical care, and as a nurse. (* “CC” is a pseudonym to protect her identity.) It is CC’s experience having a permanently damaged body from multiple medical errors that have motivated her to share her story of neglectful and abusive encounters with inept and egotistical physicians so that others are aware and can take steps to protect themselves. The medical error damage to CC was compounded by a health care system designed to respond to medical errors with mafioso tactics: deny and defend and denigrate. Nurse CC pulls no punches in telling the tragic truth of the power dynamics, push for profit, and the wholesale of humanity by the Medical Mafia.   SHOW NOTES Childhood Spinal Infection NB - some of these show notes are based on CC's preparatory notes. Those portions are CC's voice and are italicized. 0:05:00 Born in 1957 just north of Philadelphia to a white, middle class family. Grew up suburban, one of 4 children with a very tough childhood due to family dysfunction. I was extremely ill at age 6 with a spinal infection that resulted in extended hospitalization, inability to attend first grade for 1/2 the school year and confinement in a body cast and body brace for years. Despite many obstacles I was smart, had tenacity and fight that would both make me the awesome person I am today despite much suffering and societal disapproval. 0:06:05 Fought my way to be the first on either side of my family to put myself through college. I entered a collegiate nursing program in a religious institution where I hardly fit in but I had the ability, even by that point, to become a chameleon instinctually knowing how to acclimate to any environment I found myself in throughout my life. Once there, a new world opened up to me and I was on fire. 0:07:00 Began working in a hospital technical job in high school paying well and allowing me to support myself and finance my tuition, books, transportation with a small student loan. Became a RN in 1979. It was hell but I had only known hell all my life so I loved it. It felt normal. Drama, life and death, front seat row to people’s most intimate moments. However, I had empathy even at that point for any human’s suffering and this became more and more of a curse as I aged. 0:08:00 Of course I married, I was pretty, had a supervisory role within 18 months of graduation and by society’s yardstick I was doing quite well. Eventually I reluctantly had children which was interesting because I didn’t ever like children but succumbed to my husband’s wishes and that in and of itself is a miracle that I could only attribute to God. Once my first baby was born, I truly knew love for the first time in life. I wanted to be a full time Mom but this was not even a remote possibility. 0:09:30 CC chose to become a school nurse to be closer to her kids, but away from the life and death drama of ICU - CC had a 2nd child with many birth defects and she had to advocate for him - he'd be dead if she wasn't a good advocate.     Flouroquinlolones   0:11:30 When CC worked in ICU, flouroquinolones were not in common use - I have extremely hard scientific evidence that I was given Levaquin in 2002 during a surgery but that memory would never occur to me till my records had been destroyed due to laws allowing health care providers to destroy after 7 years. 0:12:30 CC was an emotional wreck after that surgery, crying all the time - when she returned to work she had a mean streak - she asked her surgeon friend for an antidepressant prescription, and that helped control her behavior. 0:13:30 In 2011, CC had bronchitis so just went to an urgent care clinic and was given Ciprofloxacin. 0:14:30 Prior to Cipro, I had been superwoman. I worked at times 3 jobs, obtained a Master’s degree and even a real estate license. So, because I was a school nurse and could be off for the summer which I never did, I remained in bed all summer. As September approached I called my internist to report this resulting in a few blood tests and being told I was just getting older. I had never been this age so I accepted this was normal. 0:16:00 CC's symptoms were extreme tiredness and weakness: she couldn't get out of bed - I drug myself to work, had been on an AD (antidepressants) since the surgery in 2002 which I knew when going back for my first post op visit I told my surgeon colleague, I’m mean. I need a SSRI, which sent me to a psychiatrist since that time. Of course all was attributed to my journey in life of mammoth stress and I happily took this which did allow me to continue at superwoman warp speed but in retrospect I had agitation and anxiety apparent but did not interfere with my ability to function. 0:18:00 CC says people in her situation are doubly traumatized when they realize they've been brain washed by the health care system she worked in - so they carry a lot of guilt as a health care worker. 0:20:00 By early 2012 I told my psychiatrist that I could barely get out of bed and he gave me a type of stimulant, not an amphetamine, called Provigil used for sleep apnea and MS (multiple sclerosis) fatigue. This allowed me to get through the work day, going to bed for a few hours at a time but I was able to earn money. 0:21:15 But I became pathetically agitated and no longer could physically be Mother Theresa as everyone knew me to be. I had anxiety to such a degree that if things were going poorly at work, I’d pick up the phone, say I was sick and had to flee on a few occasions. I knew something was wrong but I never associated the word anxiety, panic attacks to my situation. I was confused because I was being abused in the educational system but just performed at superhuman levels and now was saying no. They didn’t like that and labeled me a troublemaker and suspected of having mental health problems.   "Lamb being lead to slaughter"   0:23:30 I can trace back to late 2012 seeing a foot doc because my feet hurt but was told this was a bony deformity. I attributed it to being on my feet so much as a nurse. I never put together this was progressing small fiber neuropathy and docs certainly would never have a clue till they totally disabled me. 0:25:00 In the spring of 2013, my left foot swelled and was painful. I had done nothing. I could never be athletic because of my childhood disease but did the treadmill daily prior for decades. I saw another foot doc, told him just what I’m telling you and he ordered an MRI. He told me the MRI showed I bruised myself so I had injured myself. I adamantly said I did not, he became angry, threw the report at me to inform me I was wrong. Well I now know they are all Incompetent. So it was June 2013 and I spent that summer in bed and the swelling subsided. 0:26:15 Fall of 2013 I returned to work and immediately my right foot swelled and became painful. I no longer could rest and figured the other got better, I would muddle through. So In October, as I walked down the hallway, I felt a snap and thought this might be a breakthrough but quickly realized things got worse. I didn’t know what to do but happened to run into an orthopeadic doc from my days in the hospital, showed him my foot and said I don’t even know what specialist I should see because I’ve seen them all. He recommended his associate, a foot and ankle surgeon. I made an appointment not knowing I was a lamb being led to slaughter. 0:29:00 November 2014, I was seen and work up done by his fellow who is already a podiatrist, now doing a fellowship in foot and ankle surgery. By now the pain In my feet was unmistakably burning of my soles. I told him everything but had no clue my demise started with Cipro, but even If I had, it would never had been recognized. He did say that my symptoms sounded like neuropathy and asked If I was diabetic which I was not. Subject dropped, never recorded on my medical records I recently discovered. Follow up MRI showed severely ruptured peroneal tendon and things were too bad for rehab. Surgery was my only option. I needed a fix. I had to work so I signed for surgery December 20, 2013 so I could finish my obligations before Christmas break to minimize my sick time. Mind you I could barely walk but I was always Superwoman and this was just how I functioned even as sick as I was. 0:31:00 I had been recruited to accompany the high school choir as a pianist because of political downsizing and building politics leaving the High School Music teacher without other options. He was the president of our union and powerful. But he paid a price just like me In his lifetime. I didn’t know him well and was actually afraid of him but he was desperate, he heard I was quite the pianist , listened to me play, and said “yep, you're good enough”. Now his standards of good enough, I found out as a did this for several years, was pretty high. He was one of the most talented musicians that I’ve ever been privileged to work with. I was again on fire as I worked with him and his Choir.     Nerve block   0:34:00 He protected me when people in management were abusing me and forcing me to go against my nursing license and this was a gift. On December 20, 2013, I went into surgery not knowing the life ending decision that I was embarking on. I was given a Popliteal Nerve Block for pain control post op and receiving general anesthesia. I left, felling no pain, got my narcotics and went home very ok. 0:36:10 The following day the nerve block wore off and I began screaming at the top of my lungs. Nurses in pain, like anyone, do not think rationally, because in retrospect, I had been nursing for 20 years in a hospital and the only patients I’ve ever heard scream like that were in a burn unit in the 80’s when pain control was barbaric. I’ve also endured a natural birth of a 10.5 pound baby and I didn’t scream like that. By evening, I broke down and called the surgeon who assured me I was almost over the hump. Ha. 0:38:25 My best friend and husband stood there paralyzed in fear as I demanded the bottle of narcotics fearing I would take them all. I screamed give me 3 fucking Vicodin. I knew that wouldn’t kill me but even in those days you knew that prescription was not going to last. I also screamed that my husband had to remove the bandages because they were giving more pain. He faints at the sight of blood but I was a crazy woman. 0:39:15 Finally, the surgeon after insisting I might have a blood clot first and I said absolutely not. There’s no redness swelling, tenderness. Then he said have you ever had back problems. I say no then remembering I pulled my back out the previous June but it healed. So he orders an MRI of my Lumbar spine. The MRI is done and my back is a mess Im told (every part of my spine is gone and so Is my jaw). 0:40:30 Flouroquinolone destroys every part of the body on a cellular level - CC has degeneration of her spine - she endures 3 epidurals in an effort to determine the source of the pain 0:43:30 CC under goes 3 epidural invasive, harmful, toxic spinal injections - she has been out of work for months and in tremendous pain - epidural is a steroid that is injected into the spine to decrease swelling, but if you read the data, it does not work, it is a bogus money making procedure - the doctor tells CC her only-from-the-knee-down pain is from her back, her sciatica nerve 0:45:00 CC then undergoes a very painful procedure - the doctor realizes CC has bad neuropathy, and tarsal tunnel syndrome - he tells her to see a neurologist, but CC has to find one - Feb 2014 CC sees a neurologist 0:46:30 Just prior to the MRI date, I am In agony and my husband has no tolerance for my pain thinking I’m a whiner. I drive myself to an ER at 4:30 in the morning in desperation. I tell them my story, which I recently read their documentation and all I can say Is; are they on drugs, does anyone even listen to the patient anymore, total incompetence. I think they’ll do the MRI sooner and I can get answers. Wrong. Narcotics (Tramadol-now classified by DEA (Drug Enforcement Agency) as a controlled substance Class 4 opiate and Valium-a muscle relaxant). Prior it was considered a safe opiate.   Misdiagnosis   0:47:45 CC saw the neurologist: That man I’m sure is on drugs even though I knew I was. He kept leaving the exam room, I’d have to go out and find him, he does no neurological exam and states I need to see a neurosurgeon. 0:49:00 CC says hospitals cover up medical errors causing harm and death - CC tells about a nurse serial killer who was caught and put in jail - some nurses knew this was happening - The Good Nurse by Charles Graeber is a book about it - a nurse went to the DA (District Attorney) and they exhumed a body, but the hospital didn't tell the examiner what drug to look for based on meds being diverted in the hospital 0:51:10 The pathologist tested 100 drugs, but not the one the whistleblower nurse had reported - and the serial killer nurse went on - worked at 9 institutions - they think he probably killed 300 to 400 people 0:52:00 CC is not glad she is alive, she wished the drug had of killed her - but she loves her kids and is plugging along - I See the neurosurgeon who emphatically shows me the MRI pointing out there in NO compression on those nerves. That pain Is not coming from your spine. I get a second opinion somewhere else and he says the same. He says you have to see a neurologist and I said I did, he sent me to you. He sets up an appointment the following day in that office. 0:53:15 Unfortunately I saw a nurse practitioner but it really wouldn’t have mattered. I ask her sobbing do you think I have MS. She so compassionately comes over and holds my hand and emphatically states there is no way you have MS. Wrong. Nurses are taught never to do such a thing but she felt so confident In her skills that she violated a sacred nursing ethic. But I feel relieved as I sat in the waiting room surrounded by patients horrendously deformed by neurodegenerative diseases. She put me on Gabapentin and orders another EMG of my arms , follow up in three months with a bonafide neurologist. 0:55:30 I return to my surgeon, he sees the horrendous EMG which although abnormal, unfactual and just documentation to support another surgery which was unneeded. I’ve now been out of work for over 3 months, in desperation. He sees the EMG report says I have Tarsal Tunnel Syndrome and offers to operate on that and maybe later do the other foot. I need to work, I think this might be the answer so I agree. I’m so stupid. Desperate people do desperate things. 0:57:00 I refuse the popliteal block because my gut tells me that this is not good. I come through that surgery and while convalescing decide I’ve got to see that neurologist before July. I see him in April. He’s not only incompetent, he’s a liar I now know. He raises his eyebrows that I had the TTS and says I do not recommend the other foot. I told him what the surgeon said and he just doesn’t comment. Conspiracy of Silence.      "I asked him what he found and he refused to tell me."   0:59:00 He orders the vitamin levels I demanded reluctantly even though this Is research based. He says he wants to repeat the EMG on my legs. I tell him I have the appt for the arms June He says good do arms and legs. Wrong. 1:00:00 I show up at the hospital June 5th for the EMG with his partner. He looks at the order and starts ranting that he’s not going to do 4 limbs in one day and he’s got a splitting headache and has had a horrendous day. I offer to reschedule and he rants No. I now have been scouring the internet trying to find help because I’m even weaker. He then begins a two hour session of electrical shocks as he mutters only to himself as my friend holds my hand trying to help me through the pain. But, I finally hear him say ok, this is starting to make sense. I know he found something. When we are done I ask him what he found and he refuses to tell me. I beg him to see me because he’s the only Board Certified Neuromuscular Neurologist in the area. He says no. 1:01:30 I furiously start calling for the results. The neurologist doesn’t call me back. Finally I call and tell the nurse he better call me because if Im dying, I need to know to make arrangements. Takes days to even connect but I have now discovered there are Peripheral Neuropathy Centers of Excellence and the closest is several states away. I get an appt in less than 2 weeks. The local 2nd neurologist finally calls me back and tells me the EMG didn’t show much in those exact words. I say I’m so weak I can barely get out of bed and he offers me physical therapy. I refuse and politely tell him that I need answers so I’m leaving the state. He becomes angry putting up barriers to getting my records which ultimately I don’t need. Good people don’t care what others wrote. But because I’m a nurse, and know the ropes, I do obtain the EMG report which report which is 8 pages long single spaced starting with the statement this is a highly abnormal and complex EMG. Idiocy. Lies. 1:04:45 I go to the out of state famous guy and to my unknown luck, I show up on a day Obama was In town- I’m the only one there. All the extensive testing is done that day only needing a specialized MRI machine that is not available most places . Skin punch biopsy, 17 tubes of blood, 4 limb EMG done In less than 30 minutes. No begging for any test and more I would never have known. But he does say, because he was the first person that actually listened to me, find out the precise location on your body where they injected you for that block. 1:06:00 Two weeks after seeing the famous neurologist I return for the results but now I’m one of the herd of patients there. He tells me you have small fiber neuropathy probably from Cipro since that’s when it started but of course was placed on other neurotoxic drugs as every body organ began to disintegrate. I also have B6 toxicity which is neurotoxic (seen by the local neurologist several months earlier but never told). He goes on to explain that I had very sick nerves that could not sustain the further injury of a neurotoxic nerve block and they should have never given that to you. He adds and if you think I’m going to court for you I’m not. He states there Is nothing he can do for me. I sob and ask how I will support myself and his response was I could go on disability. He tells me he’s busy and no longer has time for me. I plead that I’m so weak I can barely get out of bed and he scolds me saying you’re not that weak. He ushers me out hysterical.       Another misdiagnsois   1:07:30 I return home. Still feeling like I’m dying and I really wish I had. On Saturday night, I’m desperate to see anyone who will help me. My long term internist had left the practice before the tendon rupture but I work with her husband. I email him and beg for his wife to call me and she does. I ask her the name of her Internist as I’ve seen multiple ones with no help and she tells me. 1:08:30 I see that internist shortly and am too weak to even sit upright to speak. She, upon entering, demands I sit up to speak. I cry and tell her I’m too weak. She does listen o my story and has a fuller history to more accurately understand. After my story her response is let’s do a brain MRI because they’ve MRId everything but that. I get that done and she calls me the next night telling me it looks like I have MS. I need to see that kind of Neurologist. I tell her I will not see anyone local. She sets me up with the nearest big city prestigious university head of MS. 1:10:00 That guy was not only Incompetent, he abuses human beings. He demands further invasive testing which was done there and my civil rights were violated and I was treated like an animal. 2 weeks later he tells me there is no doubt I have MS and wants me on toxic drugs immediately. I’m scared but too abused to accept this so I travel 9 hours to a nationally renowned hospital, lying in the back seat of our compact car writhing in pain. He does listen to my story. His verdict is that’s a weird story, but I have seen weird stories. But, I would not take those meds, continue to monitor your brain MRIs and if you get more damage, then take them. Good enough for me. 1:11:45 I have to return to the first MS guy and he’s angry but does not refuse to continue seeing me which many do. I have a few years of monitoring with no further damage revealed but cannot take his verbal abuse. I tell him how he’s hurting people with the things he says, he’s outraged, tries to pawn it off on me and I stand my ground and say I had someone beside me who heard everything you said. I point out the repeated things he said to me, he starts to grovel and says he never intended to hurt me. I respond, I know you didn’t so that’s the point of this conversation. You're clueless about your verbal abuse. I never go back because of that and other things. 1:13:00 In 2016 I read a medical journal article that is titled 40 red flags this is not MS. The first red flag is small fibre neuropathy. I email the lead author from a Colorado. He emails me back within 5 minutes. I tell him why I think I’ve been misdiagnosed. He says go see his coauthor whose closer. I do. The verdict there was I do not meet the complex criteria that Is universally accepted to diagnose MS. The McDonald Criteria. But I should be monitored. A recent medical publication cites 1:5 are misdiagnosed as MS some being on toxic drugs for decades. There is no real test for MS. So why didn’t the head of MS at a city prestigious university not understand the McDonald criteria? Because his big ego and status made he think he knew best. Scary.     Black Box Warnings   1:14:00 CC says recent research shows 1 in 5 MS patients have been misdiagnosed, and they may have been on toxic medication for decades 1:16:00 Black Box warnings on medication come from reports of harm from patients, it is not doctors submitting reports of adverse reactions - there is 1 doctor who is an adverse drug reaction researcher and he is a good man - he is the reason many of the Black Box warnings are at the FDA - CC contacted him and told about her symptoms 1:17:30 Small Fibre Neuropathy (SFN) - basically damage to the nerve - there is also Large Fibre Neuropathy, diabetics get - in MS patients, they experience neuropathy because the damage in their brain manifests the pain, not the peripheral nerve 1:18:45 The pain after her surgery was so bad CC would not have survived without an opioid - she had been prescribed Tramadol, but it was not labeled as an opioid, but it is an opioid and more dangerous than others 1:20:00 1.5 years later I’m (was) still on Tramadol for self preservation and having been told by a Johns Hopkins peripheral nerve neurosurgeon that after 9 months that nerve was not going to heal. My only options were meds or a spinal stimulator implantation. Now I’m near total psychosis. I’m obsessed with death In that I cant stop reading about It. I get pleasure from this. I sob 24/7. I can’t leave the house because I’m a public spectacle. I never ever took more than was directed. One day I take it, start to sob more and realize this poison is making me worse. I abruptly stop them. I go into withdrawal and writhe in pain everywhere for weeks. But when it’s over, my horrendous anesthetic nerve injury pain is gone. My brain was recreating the pain to get the Opioids. Tramadol was labeled in August 2014 by the DEA a a controlled substance, so providers didn’t think it was addicting even though it was an Opioid. Now we know about the corruption between the FDA and Big Pharma and the Opioid Crisis is the tip of the iceberg. My psyche Improved but I will never be normal. 1:22:30 The last years have been spent looking for The Holy Grail, trying alternative medicine and therapies but I now know my life is over. I will never work again, my personality is different as is my perception of people. One by one you r abandoned by friends, coworkers, family, religious entities and finally God. I live in unbelievable pain 24/7 that cannot be relieved unless I risk further brain injury. I’m too weak to leave the house and spend much time in bed. Very little left. I see that my situation Is the result of global profit driven societies from the rich down to the poor. 1:23:30 CC goes for stem cell therapy in Mexico as did others poisoned by flouroquinolones - and CC did respond well, but every body else got worse - CC's quality of life improved enough she could connect with others globally for mutual support - they all have multi system damage - CC was treated better by Mexican health care workers than any American. --------------------------------------------------------------------------------- Be a podcast patron Support Medical Error Interviews on Patreon by becoming a Patron for $2 / month.  Or $5 / month to be a Premium Patron and watch the video versions of Medical Error Interviews. Be my Guest If you are a survivor, a victim’s surviving family member, a health care worker, advocate, or policy maker and have a medical error experience you would like to share, send me an email with a brief description of your experience:  RemediesPodcast@gmail.com  Scott Simpson:  Counsellor + Podcast Host + Patient Advocate I am a counsellor, patient advocate, and - before I became sick and disabled - a passionate triathlete. Work hard, train hard, rest hard. Like me, many of my clients at Remedies Counseling have experienced the often devastating effects of medical error. I have been living with HIV since 1998, and thanks to research and medications, it is not a problem in my life.  I have been living with ME (myalgic encephalomyelitis) since 2012, and thanks in part to medical error, it is a big problem in my life. Need a Counsellor? If you need a counsellor for your experience with medical error, or living with a chronic illness(es), I offer online video counseling appointments. **For my health and life balance, I limit my number of counseling clients.**  Email me to find out if I have any counseling appointments open:  RemediesOnlineCounseling@gmail.com Remedies Counseling - Making Life Better Have you had traumatic experiences with the health care system? Are you living / struggling with a chronic illness?  Do you need a counsellor with proven expertise and experience to make life better? Book an appointment with Scott online at RemediesCounseling.com RemediesOnlineCounseling@gmail.com

Jeff chats with the founder of Super Fun Productions, Rob Healy, about his passion to better understand the neuroscience behind various smart drugs (nootropics) that can improve memory, creativity, cognition, and can stave off age-related memory decline. We talk about the long term dangers of stimulants, the racetam class of drugs that are banned in the United States, and the "limitless" drug Modafinil.  Jeff Grace (host) @jeffgrace (Twitter) @jeffgrace (Instagram) Rob Healy (guest) @parttimerob (Instagram) @PartTimeRob (Twitter) Mentioned in this Episode: Note: Please consult with a doctor before taking any of the supplements listed below. RACETAMS - Class of drugs that are legal in EU and Canada, but yet not in the United States. Discovered in the 1960s and have been clinically studied since the 1970s. Much safer class of drug than Amphetamines, that posses very low toxicity and lack serious side effects. Scientist believe Racetams help with ATP synthesis and Acetylcholine function. Other studies show it improves mitochondrial function in Alzheimers patients. Aniracetam - Rob's favorite for creative professionals. Enters blood stream quickly and slightly stimulatory. Fat soluble, so need to have some fat with it (fish oil or whole milk). Helps with memory formation, learning ability, increased creativity, and holistic big picture thinking. Piracetam - The first discovered and the safest because of its oldest use profile. Claims it can increase word recall, focus, attention, and memory. Phenylpiracetam - Same as Piracetam but 10x stronger. Banned by the Olympic Doping agency. Does cause sleep disturbances so want to take this in the morning. Only take this 1-2 times a week because you will acclimate quickly. Seems to be good for attention switching and task switching as well as hand eye motor movement. Oxiracetam- The computer programmer or "hacker" drug. Great for neuroprotection and recovering from head trauma. Recommended for recovery from concussions. Enhances long term memory formation. Few studies that show it's better at memory formation and recall than Piracetam. One study showed increased reaction times, as well. AFANILS - Modafanil (aka Provigil or Modalert) and Adrafanil. Rob does not strong endorse. "Wakefulness Drugs" originally designed to treat narcolepsy that may help people avoid dips in energy, but do not increase focus, reading comprehension, or word recall in ADHD brains in same way stimulants would. Popularized by Bulletproof Coffee founder Dave Asprey. Inspiration for the film and television series, "Limitless". SUPPLEMENTS THAT ARE EFFECTIVE WHEN PAIRED WITH CAFFEINE... L-THEANINE - Exists naturally in Match Tea. Best taken with caffeine. Has calming effect, or anti-anxiety... makes caffeine or stimulant highs feel much smoother- rounds them out and relaxes the "jump out of your skin feelings". This is a coffee must have. Improves memory and learning. Aids in immune system, increases t-cells, has some antibacterial properties. Lowers blood pressure. Big Fan. TYROSINE - Dopamine precursor. Amino acid to refill your dopamine stores. Stress relieving properties as well. Great supplement for depressed people as well. Also have a super hectic or stressful work week... load up on tyrosine. VASOPRESSIN - Take and wait 30-45 minutes to increase recall at lectures or in other events where elevated recall would be important. CENTROPHENOXINE - Increase recall speed. This increases oxygen to the brain and helps with glucose uptake. Brain uses 20 percent of the body's oxygen levels so you gotta make sure oxygen flow to the brain is constant as we age. LIONS MANE - Helps regulate blood glucose. Increases nerve growth factor that help neuron growth and maintenance. One of Rob's highly recommended adaptogens. Suggested as a supplement to coffee (but with some bitter taste.) FOUR SIGMATIC COFFEE - Instant coffee that contains Lions's Mane and Chagga Mushrooms linked to cognative brain function improvements. HUPERZINE A - Probably one of the oldest nootropics. Goes way back. So going back to Acetylcholine.... Huperzine prevents its breakdown in that synapse. So it prevents the reuptake and make you use more of your ACH.) BACOPA MONNIERI - Helps with memory and retention but gotta take it consistently over a long period of time. Over the Counter. KRILL OIL (Omega 6) - Krill seems to have the highest effectiveness of the fish oils to reduce gut inflammation that can result in slower oxygen flow to the brain. CHOLINE (a neurotransmitter) - Suggested to "stack" with Racetams. Many benefits to Choline supplementation in facilitating of acetylcholine production in the brain. Acetylcholine is sort of like a specific stem cell for the brain in that it can promote neuroplasticity and brain regeneration.  Good supplements to take for to help stimulate Acetylcholine production: alpha-GPC, choline bitartrate, choline citrate or CDP choline. Additionally show to have positive affects: Acetyl-L-Carnitine, Ashwagandha, Ginkgo Biloba, and Vitamin B. Music by Michael Sempert WestChannel.com | Michael Sempert on Spotify Check out the latest episode of Self Obsessed with Jeff Grace. Get your self-help obsession fix now!

Welcome to the Optimal CEO Podcast. This is Dr. Brian Brown. Join me on today's episode where we'll be discussing how I went from depressed and suicidal to naturally restored and ended a 16 year relationship with psychiatric medications. Thanks for joining me today. Last week, I explained how I discovered at age 45 that I'd been dying every single night since age 5… and how that journey gave me a profound appreciation for functional & integrative medicine. I also discussed why a blended approach is the best approach to wellness and why many wellness gurus are off-base when they tell you that their way is the only way because it's the availability of blended options that bring about wellness success in this complex system we call the human body. Today, I'm gonna to continue my story and tell you how I found a way to get off of psychiatric medications after 16 years. Let's jump right in… I've been practicing psychiatry since 1998. I've treated children as young as age 5… adolescents… young adults… middle-age adults… and senior adults. In that time, I've treated thousands of patients who were not content with life. If “happy” is defined as “feeling or showing contentment,” then I've met a lot of people who were not content (not happy) with life in their present situation. Depression and anxiety are rampant in the Western world, yet the only answer that traditional medicine seems to have is in the form of developing the next “latest and greatest” magic pill. I've actually been one of those “discontent . . . unhappy” people myself. All my life, I had longed to become a doctor. I had felt this calling since I was a young boy. It's all I'd ever dreamed of and all I ever talked about. It's what I had my sights set on. I wanted to help others and was hardwired from birth to be an empathic, caring individual. Also, in my mind, it was a way for me to find some happiness. I developed a hardworking nature right from the start: I started mowing yards when I was nine years old and started flipping burgers when I was fifteen years old. I've done everything from changing oil and pumping gas, to patching flat tires, to driving a gas truck, to unloading trucks at UPS. I'm thankful for those experiences because they have gifted me with the work ethic and people skills I have today. Because of my hardworking nature, the academic rigors of my training were second nature to me as evidenced by being a straight “A” student through my high school, undergraduate, and graduate studies. My story actually begins in the spring of 1997 when I was in my next-to-last year of professional training. One of our lectures had just dismissed for a fifteen minute break in the middle of a four-hour stretch. It was an unusually beautiful spring day, so I went outside to get some fresh air and enjoy the tulips that were in full bloom. I went to the third floor balcony that overlooked a park, the closest thing to nature near my lecture hall. I was right in the middle of my lifelong dream on that third floor balcony. . . but I wasn't happy; somehow, happiness had eluded me. I would later realize that by this point, I had been struggling with depression for about two years and that health professionals had the highest rates of suicide among all other professions. As I stood there on the balcony, propped against the balcony railing and facing the street below, I saw a dump truck speeding down the road in front of me. As the truck approached, I had a flood of emotion as all of the blood rushed from my head. I became dizzy andthe whole world around me spun out of control in a maze of vertigo. My heart was racing, and I was overwhelmed by a nauseated feeling in the pit of my stomach . . . Yet, at the same time, I had a sense of immediate relief and heard a small voice whisper, “It's over now.” It wasn't a horrific voice. It was a peaceful voice. You see as that dump truck sped by, I experienced all the sensations of being thrown over the railing into the path of the oncoming truck below—I had actually envisioned throwing myself over the rail. All of this happened in a matter of seconds. I still remember that feeling to this day. I also remember, in that split second, not knowing whether it was actually happening or all a dream. Sadly, part of me hoped that it was real. When I came to my senses and realized that it was all a vision, I was scared. It rocked me to the core. I immediately had flashes of my beautiful wife and my two beautiful daughters who were three and six at the time. Guilt and shame immediately set it. How could I have such a vision? How could I even feel hope that it was actually happening? What was wrong with me? I left the balcony that day and never stepped foot out there again. I was so ashamed. I didn't tell anyone what happened until about twenty years later. And it wasn't until a year after that incident on the balcony that I confided in a colleague that I'd been struggling with depression and anxiety. She never asked about suicidal thoughts, and I never told her… And I sure as heck didn't tell her about the dozens of other times I had avoided the impulse to swerve my car into the path of oncoming traffic while driving. She put me on Prozac, and it was at that time that I began a sixteen-year journey into the world of “chemical happiness.” I've often reflected why I went on the that first medication. The only conclusion I can draw is that I was new in my profession… in the field of psychiatry… and it just made sense. It was the way I was trained. I told myself, “Brian, why wouldn't I do this? It's what I'd do for one of my patients. Some people get their “chemical happiness” fix through drugs or alcohol, and others, like me, get their fix through antidepressants.” This is how I rationalized it. Isn't it funny how we as humans will find a rationalization for most anything that we want… or anything that we are doing… just to make sense of it all. But… I don't beat myself up too much over this journey, because my knowledge was limited when I made the decision. I guess you can say I wasn't as enlightened as I am now. And… I would even add that it was this journey that has allowed me to help so many others. So… in a strange way… it had to happen… and again, here's the rationalization of it all. Now, let's get back to the rest of the story. In the course of sixteen years, I tried nine different psychiatric medications in the pursuit of happiness… medications like Prozac, Zoloft, Celexa, Lexapro, Wellbutrin, Buspar, Lamictal, Strattera, and Provigil. None of these gave me the happiness I wanted. In fact, they made me feel numb. I couldn't feel anything. I had no emotion. And on top of that, I gained 170 pounds… At 390 pounds, I guess you can say I was “fat and chemically happy,” but I would use the word “happy” very loosely. Over time, I grew to hate the very pills that were supposed to make me feel normal. And yes, I use the word “normal” very loosely also. More than anything, I wanted off these medications. I tried a number of times to stop taking them, but I failed every time. The withdrawal side effects were not fun. Did you know that the drug companies that make these medications will tell you that they are not addictive? In the purest sense of the definition, maybe not, but in reality definitely so. When you try to stop these medication and have symptoms like rebound depression… rebound anxiety… nausea… headaches… and irritability… just to name a few… there's no doubt that these drugs are causing addictive problems. Unable to effectively get off these meds, I repeated the vicious cycle of finding the next pill that would hopefully work and not have major side effects. Oh! And speaking of side effects. They are horrible! Depending on the drug, you can be excessively sleepy and want to sleep all the time OR not be able to sleep hardly at all. You can have nausea, vomiting, diarrhea, headaches, increased appetite, loss of appetite, anger, rage, irritability, no libido, erectile dysfunction… and these are just some of the most common ones. Oh… and the yawning can be terrible… yawning all the time… and there's nothing you can do about it. During my personal sixteen-year journey into “chemical happiness,” I was treating patients with these same medications that I tried… They were dealing with the same side effects… and dealing with the same withdrawal issues. I followed the mantra of my professional training and just accepted that this was the way things were supposed to be. Again, I rationalized it with another professional mantra that we were offering the very best treatments available… after all, what other options were there. How naïve that was to say that… but it's where I was at the time. During that time, I mostly treated patients who were in their mid- to late thirties and older. They would tell me that they were feeling unhappy . . . but many of them would follow it with, “But I know it's not depression . . . it's got to be something else . . . some kind of imbalance.” Most of the time, they would follow it with a laundry list of psychiatric medications they had tried—none of which worked well. Then one day, around the age of forty, it dawned on me: maybe my patients had been right all along! Maybe my medical training had failed me. Maybe the pharmaceutical industry had lied to me. Maybe there were answers outside of traditional medical approaches. I had to find a different way of doing things. From that point forward, I made it my mission to become a student of the best alternative therapies that a person could use to physically and emotionally regain happiness from the inside out. Now, believe me, I knew that walking down this road could mean committing professional suicide. You see, I had been practicing psychiatry for years now. I was a company man. I spoke for numerous pharmaceutical companies. I talked the talk and walked the walk. I believed the lockstep answers fed to me in my medical training, and, not ironically, these same answers were fed to me by the drug reps that made sales calls on me at my office. For those of you who may not know, here's a bit of insider information… a peak behind the curtain, if you will. As a prescriber, you don't get asked to be a speaker for a pharmaceutical company unless you're a high volume prescriber… that's the first thing you need to know. And secondly, Big Pharma has pockets deep enough to be very persuasive. They provide prescribers with the most recent studies… all of which happen to prove their point and sway prescribing in their direction. They are fully aware that prescribers are busy and have little time to do in-depth clinical reading of professional journals. But the proverbial rabbit hole goes deeper. All you have to do is follow the money. Open up most any professional journal, and you will find TWO to SIX page advertising spreads for this drug or that with a cost-per-ad that will rival advertising costs in major secular publications. These same Big Pharma companies are the ones that will pay $100,000 or more for a booth at a professional conference. I give you these tidbits to let you know that the information medical professionals have at their disposal is tainted… and the professional organizations are tainted… they have been corrupted by Big Pharma. I've lived it. I've seen it first hand. And, as you may recall from podcast episode one, the numbers show it. The U.S. is almost last in health outcomes and almost first in healthcare spending. When are we going to wake up and recognize the disconnect here? But, I digress. Until this point, I had been 100 percent sold on the fact that pharmaceutical drugs were the answer, but that day I had my epiphany, something inside of me snapped. I was repulsed by all the lies propagated by Big Pharma . . . lies fed to me during my education; lies that led me down a path of unrest; and lies that certainly didn't reverse my depression. I couldn't live like this anymore, and I couldn't keep poking pills down my own throat and down the throats of my patients either. You might say I had a professional mid-life crisis. I refer to it as an awakening. I remember resolving in my mind that I couldn't do this anymore. Either I was getting out of health care altogether or I was going to reinvent myself. I set out on a journey to find answers, and it came in the strangest of ways. While away at a cardiovascular conference, the keynote speaker, who was the world's foremost authority on cholesterol, said something that lit a spark in me. Here was a guy being paid big bucks by some Big Pharma brand to speak about cholesterol. Instead, what he did surprised the audience. His entire lecture was on the natural treatment of elevated cholesterol. I have to admit, I was in awe. As a former speaker for Big Pharma brands, I knew what it meant to do what he was doing. He was committing professional suicide, but he didn't care… something that I later confirmed in a conversation with him. During that conversation, he also shared some insights that changed the course of my professional career. He pointed me in the right direction, telling me who I needed to study under to gain the knowledge and expertise that I needed. I immediately started seeking that education. After studying under the guru that he recommended for less than three months, I closed down my office practice. I had never been so sure of something in all of my life. I kept doing inpatient work to pay the bills, but I didn't darken the door of an office for nearly a year and a half. I went on to train under this guru for a total of three years. During that first year of training, I began implementing the techniques on myself… and guess what? I began to feel better. I began to lose weight and keep it off. My energy came up. My mood improved. I had stumbled onto something big. I eventually stopped my antidepressants completely in the spring of 2013. Finally, I was free. I had become an escape artist! I had escaped the confining boxes that Big Pharma and traditional medicine had me trapped in. It was a beautiful thing. But something still wasn't quite right. Sure, I was off antidepressants and happy for the first time in nearly two decades. But something was off. Then, it dawned on me. I had to share this with others and help them become escape artists too. In my second year of functional & integrative medicine training, I re-opened the doors of my office. This time, I wasn't practicing psychiatry. I was so turned off by traditional psychiatry that I didn't even want to be associated with it, and I was proud that I had escaped that box and was now beginning my journey to help others escape that box too. I laugh about it today, but it took me two years to realize that I never left psychiatry. I recall coming home one day and saying to my wife, “Guess what? I realized today that I never quit practicing psychiatry, I'm simply doing it differently. I'm doing it holistically.” Always the voice of patient wisdom, my wife said to me, “I was wondering how long it was going to take you to figure that out.” You see, it wasn't enough for me to transform myself. I had to pay it forward. I had to share other people… a way to get out of the confining boxes that traditional medicine, Big Pharma, and others try to put us into. And, that's exactly what I do today. Sure, my repertoire has far surpassed natural mood management. In my office, we manage auto-immune disorders, obesity, nutritional deficits, PCOS, menopause, andropause, gut issues, and thyroid dysfunction… just to name a few. But… since this episode is focused on the natural recovery from depression, I'll leave you with this. Throughout my years of traditional psychiatry and functional psychiatry, a few things have remained consistent… Research shows that women and men in their early thirties begin to experience a decline in hormone activity by as much as one to two1 to 2 percent per year… and this decline continues through the rest of their life. I don't think it's a coincidence that according to the National Center for Health statistics, women age 40 to 59forty to –fifty-nine have the highest rates of depression over any other age group (12.3 percent in fact%)… suicide rates among men are highest in their fifties, and, regardless of gender, those age 40 to 59forty to –fifty-nine are the least happy when compared to every other age group.? Sadly, with hormone disruptors in our diet and environment, we are seeing the ages for these statistics drop. So.. is hormone decline the cause of this depression epidemic in adults age 30 and over? I certainly think it's one of the main causes. In fact, since I've been practicing functional medicine, I've developed a very good track record at helping people avoid antidepressants and helping them come off of antidepressants… all by natural means. And… now that I have a functional medicine background, when we look at those in their late teens and twenties, I often find nutrition, diet, gut disturbances, PCOS, and/or thyroid as the cause. Many of you listening to this podcast may have been struggling silently for years… Or perhaps this is a new struggle… Either way, you need the help of a functional & integrative-medicine provider because most likely your regular medical provider doesn't have the necessary information to help you take back control of your life. Don't be forced into boxes of an antiquated system that you have no business being put into… boxes that follow old, unchallenged treatment modalities. You can easily find yourself in a cycle of being bounced around from doctor to specialist to new specialist with different results and no clear answers. Sadly, when traditional medicine can't find the answer to what ails you, it will typically use depression and anxiety as the default diagnosis box to put you in. If you don't take away anything else from this episode, I want you to leave with this… Be informed… know your options… stand up for better alternatives… and find your voice!!! Join us next time where I'll be talking about the last segment in my personal story. From 390 lbs. To A Fit Without Diet Pills

I've been practicing psychiatry since 1998. I've treated children as young as age 5… adolescents… young adults… middle-age adults… and senior adults. In that time, I've treated thousands of patients who were not content with life. If “happy” is defined as “feeling or showing contentment,” then I've met a lot of people who were not content (not happy) with life in their present situation. Depression and anxiety are rampant in the Western world, yet the only answer that traditional medicine seems to have is in the form of developing the next “latest and greatest” magic pill. I've actually been one of those “discontent . . . unhappy” people myself. All my life, I had longed to become a doctor. I had felt this calling since I was a young boy. It's all I'd ever dreamed of and all I ever talked about. It's what I had my sights set on. I wanted to help others and was hardwired from birth to be an empathic, caring individual. Also, in my mind, it was a way for me to find some happiness. I developed a hardworking nature right from the start: I started mowing yards when I was nine years old and started flipping burgers when I was fifteen years old. I've done everything from changing oil and pumping gas, to patching flat tires, to driving a gas truck, to unloading trucks at UPS. I'm thankful for those experiences because they have gifted me with the work ethic and people skills I have today. Because of my hardworking nature, the academic rigors of my training were second nature to me as evidenced by being a straight “A” student through my high school, undergraduate, and graduate studies. My story actually begins in the spring of 1997 when I was in my next-to-last year of professional training. One of our lectures had just dismissed for a fifteen minute break in the middle of a four-hour stretch. It was an unusually beautiful spring day, so I went outside to get some fresh air and enjoy the tulips that were in full bloom. I went to the third floor balcony that overlooked a park, the closest thing to nature near my lecture hall. I was right in the middle of my lifelong dream on that third floor balcony. . . but I wasn't happy; somehow, happiness had eluded me. I would later realize that by this point, I had been struggling with depression for about two years and that health professionals had the highest rates of suicide among all other professions. As I stood there on the balcony, propped against the balcony railing and facing the street below, I saw a dump truck speeding down the road in front of me. As the truck approached, I had a flood of emotion as all of the blood rushed from my head. I became dizzy andthe whole world around me spun out of control in a maze of vertigo. My heart was racing, and I was overwhelmed by a nauseated feeling in the pit of my stomach . . . Yet, at the same time, I had a sense of immediate relief and heard a small voice whisper, “It's over now.” It wasn't a horrific voice. It was a peaceful voice. You see as that dump truck sped by, I experienced all the sensations of being thrown over the railing into the path of the oncoming truck below—I had actually envisioned throwing myself over the rail. All of this happened in a matter of seconds. I still remember that feeling to this day. I also remember, in that split second, not knowing whether it was actually happening or all a dream. Sadly, part of me hoped that it was real. When I came to my senses and realized that it was all a vision, I was scared. It rocked me to the core. I immediately had flashes of my beautiful wife and my two beautiful daughters who were three and six at the time. Guilt and shame immediately set it. How could I have such a vision? How could I even feel hope that it was actually happening? What was wrong with me? I left the balcony that day and never stepped foot out there again. I was so ashamed. I didn't tell anyone what happened until about twenty years later. And it wasn't until a year after that incident on the balcony that I confided in a colleague that I'd been struggling with depression and anxiety. She never asked about suicidal thoughts, and I never told her… And I sure as heck didn't tell her about the dozens of other times I had avoided the impulse to swerve my car into the path of oncoming traffic while driving. She put me on Prozac, and it was at that time that I began a sixteen-year journey into the world of “chemical happiness.” I've often reflected why I went on the that first medication. The only conclusion I can draw is that I was new in my profession… in the field of psychiatry… and it just made sense. It was the way I was trained. I told myself, “Brian, why wouldn't I do this? It's what I'd do for one of my patients. Some people get their “chemical happiness” fix through drugs or alcohol, and others, like me, get their fix through antidepressants.” This is how I rationalized it. Isn't it funny how we as humans will find a rationalization for most anything that we want… or anything that we are doing… just to make sense of it all. But… I don't beat myself up too much over this journey, because my knowledge was limited when I made the decision. I guess you can say I wasn't as enlightened as I am now. And… I would even add that it was this journey that has allowed me to help so many others. So… in a strange way… it had to happen… and again, here's the rationalization of it all. Now, let's get back to the rest of the story. In the course of sixteen years, I tried nine different psychiatric medications in the pursuit of happiness… medications like Prozac, Zoloft, Celexa, Lexapro, Wellbutrin, Buspar, Lamictal, Strattera, and Provigil. None of these gave me the happiness I wanted. In fact, they made me feel numb. I couldn't feel anything. I had no emotion. And on top of that, I gained 170 pounds… At 390 pounds, I guess you can say I was “fat and chemically happy,” but I would use the word “happy” very loosely. Over time, I grew to hate the very pills that were supposed to make me feel normal. And yes, I use the word “normal” very loosely also. More than anything, I wanted off these medications. I tried a number of times to stop taking them, but I failed every time. The withdrawal side effects were not fun. Did you know that the drug companies that make these medications will tell you that they are not addictive? In the purest sense of the definition, maybe not, but in reality definitely so. When you try to stop these medication and have symptoms like rebound depression… rebound anxiety… nausea… headaches… and irritability… just to name a few… there's no doubt that these drugs are causing addictive problems. Unable to effectively get off these meds, I repeated the vicious cycle of finding the next pill that would hopefully work and not have major side effects. Oh! And speaking of side effects. They are horrible! Depending on the drug, you can be excessively sleepy and want to sleep all the time OR not be able to sleep hardly at all. You can have nausea, vomiting, diarrhea, headaches, increased appetite, loss of appetite, anger, rage, irritability, no libido, erectile dysfunction… and these are just some of the most common ones. Oh… and the yawning can be terrible… yawning all the time… and there's nothing you can do about it. During my personal sixteen-year journey into “chemical happiness,” I was treating patients with these same medications that I tried… They were dealing with the same side effects… and dealing with the same withdrawal issues. I followed the mantra of my professional training and just accepted that this was the way things were supposed to be. Again, I rationalized it with another professional mantra that we were offering the very best treatments available… after all, what other options were there. How naïve that was to say that… but it's where I was at the time. During that time, I mostly treated patients who were in their mid- to late thirties and older. They would tell me that they were feeling unhappy . . . but many of them would follow it with, “But I know it's not depression . . . it's got to be something else . . . some kind of imbalance.” Most of the time, they would follow it with a laundry list of psychiatric medications they had tried—none of which worked well. Then one day, around the age of forty, it dawned on me: maybe my patients had been right all along! Maybe my medical training had failed me. Maybe the pharmaceutical industry had lied to me. Maybe there were answers outside of traditional medical approaches. I had to find a different way of doing things. From that point forward, I made it my mission to become a student of the best alternative therapies that a person could use to physically and emotionally regain happiness from the inside out. Now, believe me, I knew that walking down this road could mean committing professional suicide. You see, I had been practicing psychiatry for years now. I was a company man. I spoke for numerous pharmaceutical companies. I talked the talk and walked the walk. I believed the lockstep answers fed to me in my medical training, and, not ironically, these same answers were fed to me by the drug reps that made sales calls on me at my office. For those of you who may not know, here's a bit of insider information… a peak behind the curtain, if you will. As a prescriber, you don't get asked to be a speaker for a pharmaceutical company unless you're a high volume prescriber… that's the first thing you need to know. And secondly, Big Pharma has pockets deep enough to be very persuasive. They provide prescribers with the most recent studies… all of which happen to prove their point and sway prescribing in their direction. They are fully aware that prescribers are busy and have little time to do in-depth clinical reading of professional journals. But the proverbial rabbit hole goes deeper. All you have to do is follow the money. Open up most any professional journal, and you will find TWO to SIX page advertising spreads for this drug or that with a cost-per-ad that will rival advertising costs in major secular publications. These same Big Pharma companies are the ones that will pay $100,000 or more for a booth at a professional conference. I give you these tidbits to let you know that the information medical professionals have at their disposal is tainted… and the professional organizations are tainted… they have been corrupted by Big Pharma. I've lived it. I've seen it first hand. And, as you may recall from podcast episode one, the numbers show it. The U.S. is almost last in health outcomes and almost first in healthcare spending. When are we going to wake up and recognize the disconnect here? But, I digress. Until this point, I had been 100 percent sold on the fact that pharmaceutical drugs were the answer, but that day I had my epiphany, something inside of me snapped. I was repulsed by all the lies propagated by Big Pharma . . . lies fed to me during my education; lies that led me down a path of unrest; and lies that certainly didn't reverse my depression. I couldn't live like this anymore, and I couldn't keep poking pills down my own throat and down the throats of my patients either. You might say I had a professional mid-life crisis. I refer to it as an awakening. I remember resolving in my mind that I couldn't do this anymore. Either I was getting out of health care altogether or I was going to reinvent myself. I set out on a journey to find answers, and it came in the strangest of ways. While away at a cardiovascular conference, the keynote speaker, who was the world's foremost authority on cholesterol, said something that lit a spark in me. Here was a guy being paid big bucks by some Big Pharma brand to speak about cholesterol. Instead, what he did surprised the audience. His entire lecture was on the natural treatment of elevated cholesterol. I have to admit, I was in awe. As a former speaker for Big Pharma brands, I knew what it meant to do what he was doing. He was committing professional suicide, but he didn't care… something that I later confirmed in a conversation with him. During that conversation, he also shared some insights that changed the course of my professional career. He pointed me in the right direction, telling me who I needed to study under to gain the knowledge and expertise that I needed. I immediately started seeking that education. After studying under the guru that he recommended for less than three months, I closed down my office practice. I had never been so sure of something in all of my life. I kept doing inpatient work to pay the bills, but I didn't darken the door of an office for nearly a year and a half. I went on to train under this guru for a total of three years. During that first year of training, I began implementing the techniques on myself… and guess what? I began to feel better. I began to lose weight and keep it off. My energy came up. My mood improved. I had stumbled onto something big. I eventually stopped my antidepressants completely in the spring of 2013. Finally, I was free. I had become an escape artist! I had escaped the confining boxes that Big Pharma and traditional medicine had me trapped in. It was a beautiful thing. But something still wasn't quite right. Sure, I was off antidepressants and happy for the first time in nearly two decades. But something was off. Then, it dawned on me. I had to share this with others and help them become escape artists too. In my second year of functional & integrative medicine training, I re-opened the doors of my office. This time, I wasn't practicing psychiatry. I was so turned off by traditional psychiatry that I didn't even want to be associated with it, and I was proud that I had escaped that box and was now beginning my journey to help others escape that box too. I laugh about it today, but it took me two years to realize that I never left psychiatry. I recall coming home one day and saying to my wife, “Guess what? I realized today that I never quit practicing psychiatry, I'm simply doing it differently. I'm doing it holistically.” Always the voice of patient wisdom, my wife said to me, “I was wondering how long it was going to take you to figure that out.” You see, it wasn't enough for me to transform myself. I had to pay it forward. I had to share this gift to help transform other people. And, that's exactly what I do today. Sure, my repertoire has far surpassed natural mood management. In my office, we manage auto-immune disorders, obesity, nutritional deficits, PCOS, menopause, andropause, gut issues, and thyroid dysfunction. But… since this episode is focused on the natural recovery from depression, I'll leave you with this. Throughout my years of traditional psychiatry and functional psychiatry, a few things have remained consistent… Research shows that women and men in their early thirties begin to experience a decline in hormone activity by as much as one to two1 to 2 percent per year… and this decline continues through the rest of their life. I don't think it's a coincidence that according to the National Center for Health statistics, women age 40 to 59forty to –fifty-nine have the highest rates of depression over any other age group (12.3 percent in fact%)… suicide rates among men are highest in their fifties, and, regardless of gender, those age 40 to 59forty to –fifty-nine are the least happy when compared to every other age group.? Sadly, with hormone disruptors in our diet and environment, we are seeing the ages for these statistics drop. So.. is hormone decline the cause of this depression epidemic in adults age 30 and over? I certainly think it's one of the main causes. In fact, since I've been practicing functional medicine, I've developed a very good track record at helping people avoid antidepressants and helping them come off of antidepressants… all by natural means. And… now that I have a functional medicine background, when we look at those in their late teens and twenties, I often find nutrition, diet, gut disturbances, PCOS, and/or thyroid as the cause. Many of you listening to this podcast may have been struggling silently for years… Or perhaps this is a new struggle… Either way, you need the help of a functional & integrative-medicine provider because most likely your regular medical provider does not have the necessary information to help you take back control of your life. Don't be forced into boxes of an antiquated system that you have no business being put into… boxes that follow old, unchallenged treatment modalities. You can easily find yourself in a cycle of being bounced around from doctor to specialist to new specialist with different results and no clear answers. Sadly, when traditional medicine can't find the answer to what ails you, it will typically use depression and anxiety as the default diagnosis box to put you in. Be informed… know your options… stand up for better alternatives. Alright, that concludes today's episode. Next time, I'll be talking about the last segment in my personal story. From 390 lbs. To A Fitness-Work-In-Progress

Welcome back to our weekend Cabral HouseCall shows! This is where we answer our community's wellness, weight loss, and anti-aging questions to help people get back on track! Check out today's questions:  Sasha: Hi Dr Cabral, I absolutely love your podcasts, I've learnt so much! I have Candida, which I think may be the cause of my seborrheic dermatitis which I am struggling to keep under control. I'm following a Candida diet with low carbohydrates but am having trouble keeping the sugars to a minimum. I am a type 1 diabetic, so I need sugar to recover from hypoglycaemia, even though I've lowered my insulin doses. My diabetes is well managed but because of the low carb diet, my blood sugar is often around 4-5 mmol/L, which I watch closely and need to eat glucose tablets/fruit juice/fruit throughout the day. I worry that I won't be able to get rid of Candida because I have to eat sugar to recover from low blood glucose, which will keep feeding the Candida. What can I do? Don: I was wondering what your thoughts were on dental issues that my son went through recently. Every time we took him in for his checkups he had a cavity. All these cavities were very small and easy to fix. But when our dentist did x-rays once he turned 5 years old, we discovered his molars were in terrible shape, and one tooth had exposed nerves. We were referred to a pediatric specialist that did an exam and laid out her treatment plan. Total he had 6 cavities, and needed four crowns. The specialist reassured us this was not due to lack of brushing, or a poor diet, it was just our son. She recommended we brush his teeth for him, floss, and have him use a fluoride rinse twice a day. While my son was going through all of this I read a book called Cure Tooth Decay, by Ramiel Nagel. The author made a couple of suggestions for things to do to help cure tooth decay naturally. First was Royal Butter Oil and Fermented Cod Liver Oil from Green Pastures, and a tooth paste called Theodent, which is fluoride free and supposed to help rebuild and harden his teeth. We started him on both of these right away. That was about a year ago, and his recent checkups have been good with no issues. I have no way of knowing which is helping, but I do know he hasn’t been sick nearly as much so I feel the butter and cod liver oil made a difference. I’m happy his teeth are better, but I’m concerned there is more going on internally. I was wondering what your thought are? Should we do some testing, or are there some supplements you recommend? Thanks Don Anonymous: Hey Stephen I think i have a what you would called a typical girl question :) I am an active 30 year old girl who is very healthy. I eat whole and non processed foods, good cold pressed oils, I am vegan, try to sleep more than 7,8 hours. I am very thin but not skinny. I take some supplements for my body to be healthier and because I had some pain in my intestines last year (l glutamine, zinc, vit d, curcumine, b12, omega 3). Now it's better! I usually do a lot of sport: pilates, yoga, swimming pool and a lot of walks but I have cellulite and feel pretty bad about it. I am what you could called a skinny fat person. The problem is that I put so many efforts to have a thin and strong body but apart from being maybe more firmly, the cellulite and fat are still here. I don't want to fall into a bad diet, but I am just lost and very frustrated. It's like eating very healthy, doing sacrifices about foods and wake up early to do sport most of the time doesn't count! Just in case of, I stopped the pill that i had been taken for 13 years, 2 years ago, for acne My period is quite irregular but it is improving. What do you think it could be linked to? hormonal issues please cheer me up :) ps: i have another problem:I can not run anymore, nor do strength training as my knees are too sensitive (5 years ago i had tendinitus and since then I'm not free to do whatever I want). It's like my whole body is weak, although i could run a marathon in my head. It is so sad to see other girls at my age being free to do any sport they want and me being stucked in just a few ones and ended up being hurt. I don't know if i am the only one to be in this situation I don't know how to be able to do the sport I want without ending up injured, though I know a lot about sport and good postures! Thank you so much for your advise and please send all your tests in France! It would be a great success :). International Cabral concept!  Bryan: Hello, I'm interested in the program and would love to find out more about which tests I should take for my certain situation. The main issues I'm having (and have had for a long time) is brain fog and low energy. I'm 31, 5' 7", 152 pounds and feel like I eat pretty healthy for the most part. I'd love to find out why I've been feeling this way and hopefully how I can turn it around. Thank you and look forward to hearing back! Best, Bryan Emily: I was diagnosed with narcolepsy 4-5 years ago. I have struggled with excessive daytime sleepiness since I was in middle school, but was not diagnosed with narcolepsy until I was 25. I have tried several types of medicine to help with my excessive sleepiness including Ritalin, Provigil, and Xyrem. I have experienced many different side effects from the medication. Unfortunately, none of them have been positive towards the sleepiness. I am wondering if you have had experience with a patient with narcolepsy before and if you can recommend a specific diet or natural supplements that can help with the excessive sleepiness, and finally what test kit you would recommend to see if there are any additional underlying reasons for my excessive sleepiness. My goal would be to be completely off medication, but with this neurological challenge, it is hard to keep a job without the support. I eat a healthy diet and exercise (HIIT) 3-4 days a week. Any suggestions are appreciated! Eva: Hello Dr. Cabral, my name is Eva and I’m a professional finswimmer of Austria in Vienna. I’m vegan and I’m listening to your podcasts since a week now. I already bought your book and I like your content so much! To my question: I normally have practice twice a day and sadly the evening practice is mostly from 6pm till 9pm (1h of weight lifting, 2h of swimming). Since want to try out a ayurvedic routine I’m curious how I can manage to eat and go to bed with and empty stomache before 10pm (the last days I just ate before practice arox 1 1/2hours before) and afterwards just came home and went straight into bed, it worked for me but I’m curious if over time my body might be in a dificiency because I’m not eating after practice. Do you have any suggestions, how would you manage it since I want a good night rest from latest 10 till 5:30am AND a adequate nutition I’m excited about your advices. Thank you so much, I’m looking forward! Julia: Hi Stephen, first of all thank you for putting out all this incredible content. My question today is about everyones favourite daytime "drug"...COFFEE. Every time I drink my sweat, especially under the armpits, smells really funky and totally unpleasant. Could this have something to do with my liver being overburdened or is there another explanation? What would be your advice on actions to take in order to smell good again? Thanks for everything! - - - Specific Show Notes & Resources: http://StephenCabral.com/967 - - - Dr. Cabral's New Book, The Rain Barrel Effect https://amzn.to/2H0W7Ge - - - Join the Community & Get Your Questions Answered: http://CabralSupportGroup.com - - - Dr. Cabral’s Most Popular Supplements: > “The Dr. Cabral Daily Protocol” (This is what Dr. Cabral does every day!) - - - > Dr. Cabral Detox  (The fastest way to get well, lose weight, and feel great!) - - - > Daily Nutritional Support Shake  (#1 “All-in-One recommendation in my practice) - - - > Daily Fruit & Vegetables Blend  (22 organic fruit & vegetables “greens powder”) - - - > CBD Oil  (Full-spectrum, 3rd part-tested & organically grown) - - - > Candida/Bacterial Overgrowth, Leaky Gut, Parasite & Speciality Supplement Packages - - - > See All Supplements: https://equilibriumnutrition.com/collections/supplements  - - -  Dr. Cabral’s Most Popular At-Home Lab Tests: > Hair Tissue Mineral Analysis (Test for mineral imbalances & heavy metal toxicity) - - - > Organic Acids Test (Test for 75 biomarkers including yeast & bacterial gut overgrowth, as well as vitamin levels) - - - > Thyroid + Adrenal + Hormone Test  (Discover your complete thyroid, adrenal, hormone, vitamin D & insulin levels) - - - > Adrenal + Hormone Test (Run your adrenal & hormone levels) - - - > Food Sensitivity Test (Find out your hidden food sensitivities) - - - > Omega-3 Test (Discover your levels of inflammation related to your omega-6 to omega-3 levels) - - - > Stool Test (Use this test to uncover any bacterial, h. Pylori, or parasite overgrowth) - - - > Genetic Test (Use the #1 lab test to unlocking your DNA and what it means in terms of wellness, weight loss & anti-aging) - - - > Dr. Cabral’s “Big 5” Lab Tests (This package includes the 5 labs Dr. Cabral recommends all people run in his private practice) - - - > View all Functional Medicine lab tests (View all Functional Medicine lab tests you can do right at home for you and your family!)  

In this episode of #Dictations, we talk about two medications that help so many of my patients, but are somewhat controversial. I'm talking about Adderall and Provigil. Enjoy!

As one of the fastest growing areas within medicine, the anti-aging business is now a $122 billion dollar industry with researchers dedicating their careers to finding the fountain of youth. Whether it be copper peptides or acai supplements, most of the anti-aging industry focuses on limited aspects of eternal youth and vitality. But my guest on today's podcast believes it is time to apply the latest research into a new area of anti-aging medicine she calls "movement longevity". In her new book , Podiatrist & Human Movement Specialist Dr. Emily Splichal explores the science behind barefoot training and how this often overlooked area of health and fitness is actually the secret to youthful movement. As an internationally-renown educator on barefoot training, Dr. Emily has traveled the world exploring the concept of movement efficiency from the ground up. Through barefoot science, fascial fitness and neuromuscular conditioning, she will show you how to survive the unnatural conditions of today’s shod society and optimize your movement patterns. From barefoot activation exercises, to vitamin supplements to protect your peripheral nerves, Barefoot Strong is a go-to guide to ensure years of efficient movement – one step at a time. As a Podiatrist, Human Movement Specialist and Global Leader in Barefoot Science and Rehabilitation, Dr. Splichal has developed a keen eye for movement dysfunction and neuromuscular control during gait. Functional and Regenerative Medicine and the role of anti-aging science as it relates to movement longevity is where Dr Splichal's passion is focused and has led to her notoriety within Podiatry. During our discussion, you'll discover: -What Emily means by the term "movement longevity"...10:15 -How do you determine your foot type and why is that important...13:00 -What a plantar receptor is and why you should care about it...21:30 -What a pre-activation response, and it's fascinating relationship to injures in Cirque de Soleil dancers...30:30 -How to setup your own foot core activation cascade...38:00 -The dangers of modanifinil (Provigil), Adderal and microdosing...49:00 -Why Emily is not a fan of Kegel exercises...53:15 -How you can release the hips and why that is important for your feet...59:30 -And much more! Resources from this episode: - - - - - - - - -Video: -Video: - Episode Sponsors -“Minimalist Look, Revolutionary Price” - - -Ben's    Do you have questions, thoughts or feedback for Dr. Emily or me? Leave your comments at http://bengreenfieldfitness.com/barefootben and one of us will reply!

This is our introduction episode.  We discuss what our goals are with the podcast and what we are looking to cover in future episodes.  After the introduction, we talk about our experiences with the research drug RAD-140 and the effects it had on each of us.  RAD-140 is being touted as a potential future replacement for Male Hormone Replacement Therapy patients using Testosterone.   It is said that RAD-140 may be just as effective with supposedly fewer side effects.  Next, we go into a discussion about the nootropic drug Modafinil aka Provigil.  We had used this drug for a  few weeks consistently to see what it did for us and if there were any effects bodybuilders could utilize in their day to day lives.  Modafinil is popular among business people, politicians, and college students looking to get an edge.  Last but not least we talk about Testosterone Replacement Therapy and some of the things that you need to watch out for while utilizing TRT.   We discuss some of the things we typically use to mitigate the side effects associated with Testosterone treatment.  We talk about our personal use and experiences with TRT and the doctors that are prescribing it.   TRT is a subject that we could probably do a whole show on.  There will be more to come on this topic.  We hope you enjoy the introduction and keep an eye out for our future episodes.

Comedian, musician and bestselling author Greg Behrendt (@gregorybehrendt) joins Matt and Andy to talk about the joys of riding bikes, Laird Hamilton shooting the pier in Malibu, teachers’ penises, cod accents, Nazis on meth, Provigil and sleep, black widow spider viruses, a correction to the intelligence story, Alan Turing music and Dr. Strange.

I have had a prescription for Modafinil for a few years now, and I have quite the thorough experience with the stuff to say the least. Before you jump to the conclusion that I have (or faked having) ADD/ADHD symptoms to get a prescription, let me preface this by saying that Modafinil IS NOT a drug prescribed to treat attention deficit disorder symptoms.…

This week on YKWD We have Joe List, Annie Lederman, Sam Morril, Joe Machi, and Davian Velez! Joe claims to have an inoperable tumor but nobody believes him. List, Machi, and Annie share a great story about the time they went to the Just For Laughs Comedy Festival. We also take some questions from some young comics who came to hang out! This one is a hoot! Watch/Listen and enjoy!   RiotCast.com

Modafinil was originally developed in France and in 1998, was approved by the U.S. Food and Drug Administration for the treatment of narcolepsy. It is a wakefulness-promoting agent (or eugeroic) used in the treatment narcolepsy, shift work sleep disorder, and excessive daytime sleepiness associated with sleep apnea. It has experienced widespread off-label use as a cognition-enhancing agent and has been associated with and aggrandized by the movie Limitless starring actor Bradley Cooper. In English-speaking countries, it is sold under the brand names Alertec, Modvigil, and Provigil. Modafinil is classified as a schedule IV controlled substance in the United States and is restricted in availability and usage due to concerns about possible addiction potential. In most other countries, it is sold by prescription but is not otherwise legally restricted.The addiction and dependence liabilities of Modafinil are very low. It is illegal to import by anyone other than a DEA-registered importer without a prescription. Currently, use of Modafinil is controversial in the sporting world, with high-profile cases attracting press coverage since several prominent American athletes have tested positive for the substance which is considered a doping agent. It is also under investigation as a possible medication in the treatment of cocaine and methamphetamine dependence. Seth Fitzgerald of The Drug Classroom and addiction counselor Glen Marshall explore this atypical pharmaceutical which has both unusual mechanisms of action and is increasing in popularity as a study drug on college campuses.References:https://www.erowid.org/smarts/modafinil/https://www.youtube.com/watch?v=fbWY1j-bbKAhttp://www.provigil.com/

Taylor Swift owns the world, Christina and Brett just live in it. Freshly returned from her Taycation, Christina recounts the electrifying experience of flying cross-country for a cost comparable to that of a new MacBook and counsels Brett on avoiding pesky laws when going after the drugs you need. Ignore what we say about "no show next week". Probably. We think. Brought to you by SaneBox: Stop letting your email eat you alive. Get a no-credit-card-required, 2-week free trial and $25 off your new membership when you sign up by visiting SaneBox.com/esn. Casper: premium mattresses for a fraction of the price. Use coupon code OVERTIRED to save $50 on your choice of Casper mattress. Terms and Conditions Apply. Show Notes and Links Brett meant Chris Rock's Top Five Episodes (2011) ProVigil requires a proper prescription from an accredited medical professional, and should only be procured through legally sanctioned means. All comments to the contrary of either of these statements are intended for humorous effect, and the fact this explaining-the-joke disclaimer exists is proof we live in as humorless, sad, and terrible world.

Past guest and current host of Syfy's Reactor David Huntsberger (@huntsbergerjunk) joins the proceedings to welcome a Skyped-in Jesse Case and talk about rodeo facts, the awakeness drug Provigil, buff babies, cheating in war, Chinese fire drills, Korean pears for hangovers, neanderthals' massive eyes that may or may not have caused extinction, tiny new unafraid dwarf lemurs and official Probably Science T-shirts.

https://youtu.be/zY7m5tYY3Cc

The following is a guest post by Dr. Andrew Hill, Lead Neuroscientist at . Click here for a fascinating audio podcast that accompanies this article. featuring Ben Greenfield and Dr. Hill. Dr. Hill received his PhD in Cognitive Neuroscience from UCLA in 2012, studying how attention operates in the brain. He has been employed as a Lecturer at UCLA over the past few years, teaching multidisciplinary courses on both Healthy Brain Aging and courses in Neuroscience and Psychology. Dr. Hill has published chapters on measuring and modulating human attention, and continues to research self regulation. Prior to UCLA, Dr. Hill obtained extensive experience working with both psychiatric and developmental populations as well as gaining experience in high technology areas. He received his B.S. in Psychology/Neuroscience from UMass Amherst, and is a key adviser in the formulation of the (get 20% off on your purchase with the code BEN20). --------------------------------- The Limitless Pill In the , Bradley Cooper’s character gets his hands on a smart drug (NZT-48) that enables him to be cognitively super human. The only known side effect is that his eyes change color while he is on the drug, but that changes over the course of the movie as side effects, including withdrawal symptoms, begin to get worse and worse. It’s a sci-fi thriller with a not-so-feel-good message about addiction and performance enhancing substances. And goons chasing you. Makes smart drugs sound dangerous, right? Like any good sci-fi , this movie questions our assumption on the limits of science. And some of what it is suggesting is not science fiction today. Smart drugs and nootropics are a current reality, being used more and more not to treat or remediate any active condition or complaint but towards boosting already typical or superior performance, in colleges, board rooms, military theatres, and by forward thinking gerontologists. With the wide variety of compounds available today that have some research support for cognitive effects, it is important for you to understand the risks and benefits associated with usage, or at least how to choose smarter, when choosing things that affect your brain. For example, one of the most popular misconceptions about smart drugs is that they are the same as nootropics. This may be due to similar benefits that people use them for, but ultimately they do not share the same range of effects, mechanisms of action, safety and side effects. So - what are smart drugs? What are nootropics? How do we know if something is safe or effective? What are these drugs actually doing to my brain? Why am I asking so many questions without answering them? Keep reading to get this and more information you need to understand these questions, and start formulating your own answers - and your own strategies for selecting nootropics. --------------------------------------- Smart Drugs vs. Nootropics A smart drug is generally a prescribed medication or off-label drug used primarily to treat some kind of mental or cognitive disorder. The most common are drugs such as Adderall (dextroamphetamine) or Ritalin (methylphenidate) in the stimulant class used to treat symptoms related to ADHD - although legal and illegal off-label use is rampant. And while they may promote focus and energy in some people, others have dramatic side effect, to body and brain. Smart drugs in the stimulant class also tend to be reinforcing, producing spikes in dopamine and norepinephrine. This leads to tolerance and habit formation, including adverse effects on appetite, mood stability, cardiac function, stress levels and possibly many other unwanted effects - especially on younger brains such as teens and young adults. Irritability and mood swings, anxiety, sleep issues, and other forms of emotional or cognitive regulation problems can crop up over time with stimulant use, as well. A popular atypical stimulant “smart drug” includes the narcolepsy agents Modafinil / Adrafinil, although their effects on cognition beyond wakefulness are unproven, and side effects - while rare - can be life threatening. If attention problems are already present the side effect risk appears to be significant increased, as well. (). In contrast to a smart drug, a nootropic is generally a non-prescribed compound, including vitamins, herb, other supplements, natural or synthetic compound that may increase or protect cognition in some way. The preponderance of research in the past 40 years shows some effects on focus, attention, effects on aging, and possibly cellular metabolism. To paraphrase the definition of “nootropic” as , it is something that improves cognition without appreciable side effects, or provides from protection to the brain. In a modern context we think of nootropics as something used not to treat any mental condition or pathology directly, but instead to provide support to peak function, protect against long term risk, and provide daily boost. Across the field, true nootropic ingredients and full blends can now be found largely sourced from natural ingredients. Nootropic blends are designed to leverage synergy effects suggested in the research and subjective experiences. The goals with nootropics should always be to allow for greater and more consistent cognitive effort and flow, without the side effects of a stimulant or other harsh substance. ------------------------------ How Do I Know If A Smart Drug Is Safe? As a rule of thumb, it is the nature of science to be wrong at times. We’ve come a long way since we accepted that the theory behind the Earth being the center of the universe was wrong. We understand that new research may overturn old knowledge. So how can we truly know the risks and benefits of long term use of nootropics or smart drugs? A red flag in understanding the harm of a substance is the body’s ability to handle an overabundance of this substance. Small amounts of toxic substances may be beneficial in the short term, but the magic happens when we look at what is happening in the body when we get too much. Something as simple as a cup of coffee may seem harmless, but caffeine in high amounts can cause dizziness, anxiety, and even cardiac arrest or death. Caffeine mimics the action of the neuromodulator adenosine in the body. This leads to higher adrenaline and cortisol levels. Even in typical doses caffeine can deeply affect our sleep and cause heart arrhythmias for some people. Alcohol has even worse short and long term toxicity symptoms at non-moderate doses, and some people struggle to keep their dosing moderate. In better doses - perhaps a couple cups of coffee a day (without sugar) and a drink or so per day on average, these substance are actively health promoting, and reduce risk for many brain and cardiac diseases. When you are picking substances and compounds, dosing should be cautious at first. From this, a couple rules come out - 1) don’t take any compounds, substance, or blends of substances that don’t list all their ingredients out in plain amounts. Proprietary blends with lump-sum amount hiding buzzword-compliant list of magical ingredients known as “fairy dusting” in the supplement industry. Don’t be fooled. Read the ingredients. Figure out why and what is in there, and if you want it. 2) don’t chase suspicious research chemicals without much history of use or safety profile. Experiment on yourself if you like, but you only have one brain - make rational and cautious choices. There are nootropic, smart drug, and cognitive enhancers that have been around for decades - something released last week as a “Research Chemical” with a bunch of numbers and letters for a name and no human studies isn’t worth the risk to you. Not for years. ------------------------------- What About Adderall & Modafinil Safety? Smart drugs such as Adderall can cause dangerous lows, psychosis with extreme use, rebound fatigue, and depression, even at lower use levels. As an amphetamine, Adderall can act as a reuptake inhibitor, meaning that it can compete with other neurotransmitters for reuptake. Specifically it is thought to block the uptake of dopamine and norepinephrine, which are associated with reward behaviors and our nervous system functions, respectively. This causes a flood of these neurotransmitters onto multiple receptors, causing neurotransmitter depletion and overexcited receiving neurons. This large “signal” is the reason for the focus, but also responsible for some of the side effects that go along with this class of prescription drugs. Existing research is also a bit weak on any improvement that Adderall or other stimulants may have on short term memory or cognitive function, and some actually may impair function. Modafinil, also known as Provigil, is an example of a smart drug that has been used like a nootropic. Modafinil is prescribed to treat sleep disorders, but when combined with a normal functioning brain, can potentially cause increases in cognition and awareness. Just like Adderall, the use of these drugs outside the medical field does not make them a nootropic. Modafinil is also a reuptake inhibitor for dopamine, causing the same type of neurotrasmitter flood as Adderall. However, Modafinil may also affect the histaminergic pathway, which deals with wakefulness and the delicate immune response of the body. Histaminergic neurons in the brain are more active during wakefulness and slow their firing pattern as we rest or sleep. Modafinil’s “beneficial” side effects may come from this heightened histaminergic neuronal activation, but too much activation can cause apoptosis, or cell death. In addition, this has been shown to cause adverse skin reactions that required hospitalization since the histamine pathway also deals with our immune system. Modafinil may increase your intelligence, but can be extremely dangerous to the health of your brain and body. ------------------------------- Enter Nootropics Nootropics, , and a few other products on the market, have dose-toxicity levels much lower than salt, caffeine, and especially Adderall. There doesn’t seem to be any neurotransmitter depletion, tolerance or habit forming potential, adverse body side effects, or impaired brain function, from most true nootropics, by Girugea’s definition. The mechanisms for nootropics lie within the structural connectivity of the brain, the optimization of blood flow and oxygenation, and the fortification of brain regions over long term consistency. Nootropics act more as a super supplement to protecting the brain. Girugea’s own first synthesized nootropic (in 1964) is still in use today and has been shown to have effects on mitochondrial metabolism, cell membrane fluidity, and functional connectivity in the brain. Piracetam is this poster child for nootropics, and one of the main ingredients in . It is one of the only compounds used in that formulation that can not be found in nature, however it was originally derived from - and has structural similarities to - the neurotransmitter GABA. Since Girugea bought piracetam to light in 1964, there has been lots of research to support the benefits of piracetam. It has been shown to positively affect our cell membranes and to have neuroprotective and pro-metabolism effects on cells. The fluidity in our membranes changes with stress and old age, as well as moment to moment as one method of regulating receptor activity. By keeping our membranes healthy we can promote the cells ability to communicate. For example, combines other membrane oriented supplements - including choline. The cell membrane - especially in the brain - relays ongoing control signals and messages from other cells to the inner processes of the cell. Neurons’ membranes in the axon (wiring) and soma (cell body) help generate and propagate electrical signals, sum distant signals, and even have computational and complex learning functions related to changes in membrane function.Healthier and more active cell membranes bring us increased activity and cell communication, and hopefully better cognition. Piracetam along with other ingredients such as magnesium, choline, and DHA, increases in brain plasticity and are designed to improve cognition and efficiency under processing load - or peak performance, versus remediation. Nootropics may support increased cognitive potential as well as long term protection. The team added L-Theanine and L-Tyrosine to support neurotransmitters of GABA and Dopamine, respectively. You can use a similar or different strategy when building your own nootropic regimen, but use a strategy. Know why you are putting an ingredient in, know how it might interact with the others, and be sure that dosing is safe. When you are planning your nootropic or nutraceutical regimen, think in terms of nutrition support to cell metabolism and function, amino acids, natural or near-natural compounds, and avoid bad fats and harsh chemicals that give a momentary boost at the cost of later crashing or having other more serious side effects, such as excess sugars and caffeine. And don’t forget what else you put in your mouth - additional DHA and other omega-3 fatty acids (in grass fed meats, deep sea fish) are excellent for brain health. Craft your diet like you craft your brain supplement regimen - or have both catered / curated for you in a high end product. If you do create your own blend, think precise selection, not shotgun approach, and add slowly to your regimen. -------------------------------- The Problem With Instant Gratification As a culture, we often hear false marketing claims or create mindsets about what is possible with our health. We see ads that advertise a pill that gets rid of “stomach fat fast”. Truthfully, fat is lost uniformly in the body and the fastest and healthiest way to lose weight it about 1-2 pounds uniformly a week. So we eat poorly and don’t exercise for 2 years and then criticize our healthy workout plans and diet 1 month in when we don’t get the results we want. The healthiest and most effective things in life are often the ones that we do routinely. Consistency is key. This is true if you are talking about athletic performance, academic or intellectual training, or nutrition and supplement support. While not “necessary” like supplements or medicines, nootropic use follows this principle as well. There is another rule, emerging. If something is strongly “felt” dose to dose - if it gets you high, or wired, or sedated...it’s a smart drug, recreational drug, or something that may enhancing some aspect of performance (perhaps at the expense of another), but is definitely not a nootropic. And finally, nootropics should be sustainable. With some nootropics there is an initial loading phase followed by a maintenance phase, and while subtle, results can be felt fairly quickly on the timescale of a few days. The contrasting quick highs / crashes of coffee, alcohol, smart drugs, and even quickly digesting carbs are definitely experienced more immediately, but have consequences that make them unsustainable for many people. ------------------------------ Summary So in summary - here are a few initial rules to help select your own nootropic or cognitive enhancing blend: Know your ingredients, and their amounts. Don’t spend your money on obfuscate fairy dusting or expensive blends that are full of caffeine or random research chemicals. It’s not a nootropic if it has side effects. Your nootropic solutions should focus on mild nutritive and metabolic support, for long term gains and protection. Break the cycle peak and crash that you get with too many stimulants, and avoid the more serious side effects that you risk with smart drugs. Nootropics don’t get you high, altered, or wired. And don’t forget the other accessible and evidence-based brain and cognition improving methodologies we have at our disposal today: meditation, yoga, and other contemplative (attention training) practices, biofeedback and neurofeedback, diets high in good fats, and other modifiable behaviors you can implement to take control of your brain health and performance. So take care of your brain - the tools are out there, to support health and shift performance. Leave your questions, comments and feedback at . Also, if you want to try the nootropic that Dr. Hill helped design, and get 20% off on your purchase with the code BEN20.

Dave and Tamler try to artificially bulk up their expertise on the ethics of performance enhancing drugs and end up raising a lot more questions than they answer.  Why do we condemn certain methods for boosting performance on the playing field and praise others?  Why is it OK to train at high altitudes but not in hyperbaric chambers that simulate high altitudes?  Why is Lance Armstrong a villain and Graham Greene (who wrote many of his most famous novels on benzedrine) a hero?   Is there genetic therapy to cure haunted child haircuts, and if there is, how can Tamler get access to it?  Of course, no discussion on PEDs would be complete without clips from South Park and Sanford and Son.  Also, David misremembers Lyle Alzado as a regular on an 80's sitcom because of a single appearance on "Small Wonder."  We probably should have taken some podcast enhancing drugs for this one.  LinksPerformance-enhancing drugs [wikipedia.org]Benzedrine [wikipedia.org] What do Auden, Sartre, and Ayn Rand have in common? Amphetamines [slate.com] Lyle Alzado [wikipedia.org] "Turin Sample: The nonsense of Olympic doping rules" by William Saletan [slate.com] "Brain Gain: The underground world of 'neuroenhancing' drugs"  by Margaret Talbot [newyorker.com]Adderall [wikipedia.org]Modafinil (Provigil) [wikipedia.org] "A mathematician is a device for turning coffee into theorems"  -Paul Erdos  [amphetamines.org]Up the down steroid [southparkstudios.com] Sanford and Son: "Gorilla Cookies"  [youtube.com]  

This week the guys wander the ash-grey labyrinthine hallways of House of Leaves. They discuss men of steel and iron. Tony is sleep deprived; Albert is just stupid.   Download   Links:   Immortals Kiss Kiss, Bang Bang House of Leaves Annotated (Albert thinks he remembers this being a thing, but can no longer locate it. Here is some other fan obsession in its place.) The Tall Man Sunshine Kick Ass 2 That story about Nick Cage Jim Carrey pulling his support for Kick Ass 2. Pomodoro Technique Habit RPG Provigil   A fun fact: the word pomodoro mean's "tomato" in Italian, because the original kitchen timer used for the technique was shaped like a tomato.

Dr. Stephanie Harman, Director of Palliative Care at Stanford University Medical Center, reviews the challenges of depression and fatigue related to cancer, and treatment approaches for these issues.

Dr. Stephanie Harman, Director of Palliative Care at Stanford University Medical Center, reviews the challenges of depression and fatigue related to cancer, and treatment approaches for these issues.

IQ-elevating agents that can boost brain power are being used by over 10% of university students. But how do these cognitive-equivalents of anabolic steroids for the brain actually work, what are their effects and are they safe? Moreover, is the advantage they confer an ethical one? And if not, should universities be screening students ahead of exams to deter their use? Meanwhile, in the news this week, we find out how lasers can cut complications in cataract surgery, why some people are allergic to wine, we hook up with the highlights from the world's biggest neuroscience meeting including... Like this podcast? Please help us by supporting the Naked Scientists

IQ-elevating agents that can boost brain power are being used by over 10% of university students. But how do these cognitive-equivalents of anabolic steroids for the brain actually work, what are their effects and are they safe? Moreover, is the advantage they confer an ethical one? And if not, should universities be screening students ahead of exams to deter their use? Meanwhile, in the news this week, we find out how lasers can cut complications in cataract surgery, why some people are allergic to wine, we hook up with the highlights from the world's biggest neuroscience meeting including... Like this podcast? Please help us by supporting the Naked Scientists

Cathi on Provigil and brain stimulationNora on ban on Manhunt 2

Doctors are using a new medicine, Provigil, to help people stay awake longer.  Is this a case of disease mongering?...

[audio https://garethstack.files.wordpress.com/2013/08/36_technolotics.mp3] Listen: Episode 36 Watch: Youtube Notes A Dose Of Genius Dramatic increases in the numbers of students using “smart pills” to increase concentration, focus, wakefulness and short-term memory.   Adderall, used to treat attention-deficit disorder. Sales up 3,135 per cent in the last 4 years. Provigil used to treat narcoleptics, who fall asleep uncontrollably. Sales up … Continue reading Technolotics #36 – A Dose of Genius →