Practices

Here is a question that costs nothing: has anyone in your family been told their vitamin D was low? It runs in families through genes, skin tone, where you live and how much time anyone spends outside.

The clinician telling this story found out only afterwards that his mother, father and brother had all been low. Nobody had mentioned it, because it…

Even where a herb has good evidence behind it, that evidence belongs to the plant and not to the bottle in your hand. Testing keeps turning up products that do not contain what the label says.

This part of the argument does not depend on whether herbal remedies work. You could accept every claim made for a plant and still be left with the…

Own brand products from large retailers were among the worst performers in these tests. A big name on the packet is not a quality check, however much it feels like one.

Own label goods are usually made under contract on thin margins with no independent verification of what comes out the other end. So the reassurance…

People often turn to herbal remedies hoping to avoid side effects. Plants are chemistry too, and some of them interact with prescribed medication in ways that matter.

A plant extract is not one substance, it is a mixture of many, which gives it more places to interact rather than fewer. Origin has nothing to do…

Around seven in ten people who use herbal products never mention it to their doctor. Not out of secrecy, mostly because a tea or a gummy does not feel like it belongs on a list of medications.

The useful move is to answer a wider question than the one you were asked. When someone asks what medication you take, tell them what else you take…

Your gut is not just plumbing. It makes many of the same chemicals your brain runs on and it is in constant conversation with your nervous system, which is part of why a bad stretch of digestion and a low mood so often turn up together.

If your stomach has been unsettled for weeks and your mood has slid over the same weeks, you do not have to work out which one is the real problem.…

Put a rubber band round your water bottle for each refill you want to get through today, and slide one off each time you finish it. Nothing to remember, nothing to buy, and you can see where you are at a glance.

Tracking anything in your head is hard when your head is already full, and harder still when concentration is one of the things that has taken a hit.…

You are allowed to try something because it seems sensible. What you should not do is tell yourself it is proven, because that is what stops you noticing when it does not work for you.

The idea that going without company makes you hungrier for it is a reasonable guess, and mostly still a guess. Keep it in that shape. If a quieter…

A drink does loosen people up, and that is not a reason to use it. Something can work and still be a poor way to get what you want.

This one matters because the reasoning holds right up until the moment it does not. If a thing softens you tonight and charges you tomorrow, it is…

Say it plainly when you do not know. This seems to help and I am not sure why costs you far less than confidence you cannot back up.

People trust someone who marks their own guesses. It keeps you honest with yourself too, because a claim you have labelled a hunch is one you can…

You can say what an SSRI does in one sentence. It blocks the doorway that carries serotonin back out of the gap between two nerve cells, so more of it stays there for longer and is likelier to be picked up.

Worth being able to say plainly, because most people are carrying something vaguer and more frightening than that. It also sets a fair expectation.…

The blockade is partial. Serotonin is not trapped in there forever: enzymes still break it down and the transporters that are not blocked carry on working.

That matters for accuracy and it matters for reassurance, because people do picture something flooding and stuck. It also explains why serotonin…

Serotonin syndrome comes from stacking, and the second agent is usually something nobody thought to mention: a migraine tablet, a cough medicine, a herbal remedy for low mood.

Triptans, tramadol, dextromethorphan, linezolid and St John's wort all count, as do other antidepressants. Someone who mentions in passing that they…

When someone says they react badly to normal doses of almost everything, take it as information about their body rather than as a personality trait.

Bodies differ in how fast they break a medicine down. Give two people the same dose and one of them may be holding far more of it for far longer,…

Whether a medicine works can turn on something as ordinary as taking it with food or moving it to bedtime.

Vilazodone is the clear case. On an empty stomach a good deal less of it is absorbed, and the nausea it can cause is easier to sit with overnight…

The same medicine can be dangerous given one way and safe given another. Slow release is not a marketing word.

Bupropion was pulled from the market over seizures and came back once a slow release form existed, because what drove the risk was the sharp peak…