It’s Thursday night, and I’m sitting in an airplane, about to take off for New York. I’m heading home from Las Vegas after attending Obesity Week 2019, the world’s largest obesity medicine conference, a collaboration between The Obesity Society and The American Society of Metabolic and Bariatric Surgeons.
I don’t quite know how to express my feelings and thoughts about this event, but the words ‘anger’ and ‘hopelessness’ immediately come to mind. My anger and hopelessness are best exemplified by the first keynote speech, delivered by Dr. William Cefalu, who is chief scientific and medical officer of the American Diabetes Association.
After accurately describing our country’s spiralling healthcare costs, and the morbidity and mortality associated with diabetes and obesity, Dr. Cefalu went on to discuss the benefit of low-calorie approaches for diabetes reversal. He also highlighted bariatric surgery and medications. But ultimately, he harped on one point, that is frequently repeated at conventional obesity medicine conferences:
“There is no best diet. The best diet is one that a patient can adhere to.”
The above article by Dr. Tro Kalayjian the physician behind Dr. Troys Medical Weight Loss and Direct Primary Care is a discussion about why it is so difficult for the medical profession to accept fundamental changes in medical understanding about diabetes and current treatments for it. It is why patients continue to get contradictory advice from doctors who really ought to know better than to recommend any number of established and well known dietary strategies that simply don’t work. It’s not that they don’t work anymore, it’s that they never worked, and there is no scientific basis for any of them.
This sounds pretty revolutionary to me. The esteemed Canadian doctor is joined by a number of US based colleagues who are challenging the status quo in the treatment of diabetes, and sending a message to their profession. Just stop! Stop misleading the public! Stop lying to patients! Stop killing your clients!
Of course, they are doctors and they don’t quite put it that way. But what else can you say when so many health professionals and authorities continue to promulgate misleading information, such as “moderation is the best strategy” when clearly, based on current information that is simply not true. Moderation will kill you if by moderation you include relatively mundate advice about carbohydrates and sugar. What sciences know is that consuming carbs in excess of certain pretty limited amounts leads to metabolic syndrome, metabolic syndrome leads to insulin resistance. Insulin resistance leads to diabetes. Diabetes leads to lots of really bad stuff that can kill you, or at the least, make you really really sick.
If you or someone you love is fat, obese, or has diabetes or prediabetes follow the link on this blog entry to the above article and understand what is being said. Doctors are willfully ignoring solid medical evidence in favor of standing by old, disproved theories because they are afraid of rocking the boat. Read Dr. Fung’s book, the Diabetic Code.
Stop believing anyone who says that eating many small meals a day is ok. Stop following advice so far heard that has led you to being overweight and obese. If you want to live and healthy, long life, fire your current endrochronologist if he or she disparages the most recent research and tells you not to follow Dr. Fung’s advice. Run away from anyone who says that carbs and sugars are not the cause of diabetes, metabolic syndrome, and many many many other life threatening diseases.
Ivor Cummins is an Irish medical professional who is leading a charge to redefining the causal relationship between metabolic syndrome, insulin resistance, diabetes and a whole slew of diseases including heart disease and cancer.
In my pursuit of better health I am committed to radically reducing the amount of carbs in my diet, as well as resetting the hormonal imbalance in my liver and pancreas. Dr. Jason Fung is doing his work as a doctor in Toronto, as well as publicizing the real risks of abdominal fat.
The real crisis in today’s world is a crisis in lifestyle and diets, which is putting millions and millions and millions of people all around the world in grave danger. More people die every years in the world NOW from diabetes and related illnesses than are predicted in the worst 50 year estimates of global warming. The people dying today are dying because science has been systematically ignored by government policy makers and medical professionals for 50 years.
Dr. Fung argues that the conflict of interest between industry and medical professionals, including government agencies is at the heart of this global crisis. It is time to stop mollycoddling international business interests, and get on with the business of teaching future generations how to improve the quality of their lives, while also radically extending the length of their lives, simply by learning new lifestyle choices.
No matter how far we are going on a journey, each step is a new beginning. When I began intermittent fasting, back in July, I knew from the start that it is a long term project, and progress measured in weeks, months and even years. My incentives for giving it my best shot are huge – better health, a longer life and a more enjoyable and energetic present.
What I didn’t know, at least not in my heart, is that every day would require a new, fresh commitment to the plan. I sort of thought that my inertia would carry me along long enough to sustain me until I reach my goals, which are tangible, measurable and, hopefully, achievable.
Well, no such luck. Almost every day I fast I find myself feeling extremely positive about what I’m doing. Almost every day I’m not fasting I find myself haunted by doubts. I feel like I’m not losing weight fast enough, I’m not managing my insulin and medications well enough, and whatever I’m eating is working directly against my goals. I see a perfectly normal person walk by and I think to myself, “What a fat slob”. Because I’m afraid that somehow I’ll lose my commitment and indulge myself in foods that I don’t even really like or want anymore.
And I’m still less than a half the distance to my weight loss goal, and still unsure about how long it will take me to get to the point where I don’t need my diabetes medications and insulin any longer. I guess I’ll know when I get there, because both goals are measurable, and there is external evidence that I’m making good progress on both fronts. But in the meantime, I feel a little bit lost at sea, from time to time. The worst times are when I’m eating, and wondering if I can really afford this whatever.
I also know that even when I reach my weight goal, and my ambition to defeat metabolic disorder, and eliminate my diabetes, that I will then have to undertake another journey. Maintaining my healthy body will require vigilance, and committing to a healthy low carb diet, not for a while, but for the rest of my life. So the change I am currently experiencing through intermittent fasting will only be sustainable if I commit fully to the change in lifestyle needed to maintain the results.
This doesn’t discourage me, but it does present me with a challenge in the present, which is that my level of commitment to a certain and achievable weight and health goals must be followed by an endless journey, if the effort being made now isn’t to be completely wasted.
At that’s just a little intimidating. Well, maybe not just a little. Maybe a lot.
In an article I read today in Endocrine Web, by Kathleen Doheny
Every year, about 1.5 million Americans learn they have diabetes. However, there are more than 7 million adults who have diabetes but haven’t been diagnosed, according to the American Diabetes Association. This matters since we are learning that the best chance of reversing diabetes seems to occur very early in the onset of the disease. Finding from several recent studies indicate that the timing of diagnosis matters a lot.
If you have diabetes, your doctor may have encouraged you to consider making lifestyle changes; for many, that may include losing weight. While that same message has been discussed for years, recent evidence suggests that achieving about a 10% weight loss may be even more important than experts thought—with a payoff that is greater than previously imagined.
So you don’t have to lose all your excess weight to get a benefit from weight loss. As noted above, even a weight loss of 10% has a powerful effect on your A1C levels. This should be a great incentive for diabetics who, like me, have been identified as obese, or even merely fat or overweight.
After nearly three months I can say that fasting is making my health a little better, including reductions in A1C but also including things like mobility. I can actually reach down and touch my toes for the first time in a long time. Fungal infections have been radically reduced already. And my sense of hope for the future is significantly better.
What some authors have written about is the profound effect that fasting and weight loss have on the emotional health of a person. This may be something I’m prepared to write about in the future, but right now I feel like I’m on a roller coaster emotionally, really happy with my results one moment, and anxious about further progress the next.
My wife was diagnosed with Type two diabetes about the same time as I started my fasting program. She tried fasting the same amount as did I, but found that she simply couldn’t sustain a fast for so many hours, so she reduced the fasting to 16 hours and also continued to cut carbs and sugar in the rest of the day. Barely two months into her lifestyle change, including the reductions in carbs and sugar, she managed to reduce her A1C from 11+ down to 7.4.
She also lost some weight but not really that much. The thing is that her BMI is a healthy 24 so she really didn’t need to lose weight, as much as she needed to reduce carbs. A ten pound weight loss translated into a radical change in her blood sugars, and indeed in her medication requirements after the test.
I’m really proud of her accomplishment is such a short time, and firmly believe that if she continues in this direction that she will effectively a “non-diabetic” by spring, if not sooner.
I still hover around 215 pounds, but my blood sugars came down to 7.0 from 8.1 two months ago. My family doctor was pretty surprised and pleased with my progress. The biggest thing I keep reminding myself is that Rome wasn’t built in a day. My obesity is the result of 25 or 30 years of overindulging carbs and sugars, and it’s taking me some time to get the weight off. So be it. I already notice and now so are some of friends and family.
For the first time since I started this new lifestyle and intermittent fast, I am feeling a little discouraged. My weight has been fluctuating up and down between 215 and 225 pounds for a week. I thought once it got down to 215 it would stay there, but no. So I looked back at the week, and realize that I haven’t actually done anything inconsistent with my program.
So what is going on? I also notice that my blood readings have been running much higher all week, on fasting days as well as on eating days. What’s with that? Maybe I reduced my insulin too much too soon…. I don’t know but it’s discouraging. A bit. From what I read in the literature about fasting, it is seldom a straight line downwards in weight, and adjusting my insulin every day and every night is a little hit and miss.
Necessarily so, since the body isn’t actually just a machine, but is indeed an organic whole system, which I’ve been messing with for the last three months.
Today was my first day of fasting for this week. And I’m sticking to it, even on the bad days. Tomorrow with be a better day. Maybe not. But a tomorrow will be a better day if I stick to my guns and follow the program.
Hang in there with me, folks. The ride’s a little bumpy!
At the end of another week of three 36 hour fasts, I’m contemplating how much my life has already changed, and how much it may still change, as I continue my fasting and attack on diabetes.
First of all, I currently weigh about 30 pounds less than when I started on the low carb high fat program. Fasting started about two weeks later, after I took the time to consult with my endocrinologist about how to manage my blood sugars during my fasting. We had already switched to two different types of insulin, long acting and fast acting, and I’m using the new meter that tests all day long, so he felt that the risk of a dangerous low could be managed.
Secondly, I now know that fasting isn’t really all that hard, for me. I suspect that motivation is a huge part of this, but fasting seems pretty straightforward to me now. Take care of my insulin and blood glucose levels, otherwise just don’t eat. Anything. Instead of it being hard, it’s been pretty easy, and the results so far are gratifying.
I made the change to my lifestyle on July 10, and began fasting near the end of the month. It’s now the end of the first week of September so I’m approach two months into the program. My insulin levels are lower than ever as are my glucose readings. I take half of the prescribed dose of long acting insulin these days, and no fast acting insulin at all on my fasting days, and about three quarters of the previous prescibed dose on my non fasting days.
The biggest concern is keeping my blood sugars high enough not to end up in a coma from hypoglycemia from having too much insulin in my system and lowering my blood sugar too much. In more than 20 years of trying to manage my diabetes low blood sugar was never ever a remote possibility, even after being on insulin, as my blood sugars were always higher than desireable.
I recently made two new holes in my belt to keep my pants from falling down, after moving from the last belt hole at the other extreme. I didn’t measure my waist when I started because I was too embarrassed to admit how big I had become. Now I wish that I had because I’m shrinking fast.
When I started this fast, I told myself that I would stay the course for three months, and then re-evaluate where I’m at then, from a health perspective as well as general feeling perspective. I also said that I would be happy if I were to get my weight under 200 lbs or 90 KG by the end of the 90 days of fasting. Today I weigh 217 lbs, down from 244 lbs on July 10th. I believe that I will achieve both goals, at which time I will commit to the next phase of this program.
I wish I could say that there have been no negative effects of fasting. It’s a little early to make that statement. What I can say is that there haven’t been any, so far.
I’m current working through the discovery that diabetes and obesity are the evil twins of post-second war American policy in health care and diets. If you read about the history of high carb, low fat diets you soon discover that the United States, and the rest of the world, were conned years ago, about the benefits of high carbs and the dangers of fat, any fat, but especially fat from animal sources. These policies were initiated by the National Health authorities to try to reduce heart disease but instead have led to several generations of increasingly unhealthy populations.
Children don’t eat too much. But their choices are influenced by what they are taught by their parents as well as what they see in the media, and on social media. All of the sources of information are tainted by misinformation pumped out by a combination of well meaning but uninformed dieticians, medical doctors, school authorities, health boards and urged on by corporate interests who make money selling foods based on this advice. Eating foods that inevitably bring on obesity, as surely as clouds bring on the rain, is dangerous. Childhood habits encourage the eating of carbs and sugar, rather than healthier alternatives.
Our generation is perhaps the last generation that needs to be poisoned by the demonization of fats and the promotion of carbs and sugars. The recent book by Dr. Jason Fung, the Diabetes Code, should be must reading for everyone responsible for feeding themselves, but especially for anyone responsible for giving advice on healthy eating and living.
I started an intermittent fast a little over a week ago. By this I mean that three times a week, for 36 hours in the row, I don’t eat anything.
On the days between my fasting, I eat less than 150 carbs including sugars, but mostly avoid anything with added sugars. I do eat some fruit in the form of berries, apples, bananas, and other fruits, but no more than two servings (basically half an apple is one serving).
My plan is to do this for at least three months, or until I don’t need to do it to get rid of my diabetes. I’ve had diabetes for a long time, and have been on insulin for about 10 years or so. I’ve been told all of my life that diabetes is incurable, but treatable with diet and exercise. My doctors have always told me that it is a progressive disease. Over time it gets worse and worse. Which it has in my case. That is, gotten worse and worse.
My doctor and I decided to try the new patch and Free Style Meter, along with long lasting insulin and fast acting insulin. Basically my previous insulin regime had caused me to increase my weight to 245 pounds. I’d already been diagnosed as obese by my family doctor for more than twenty years, and I’d never weighed more that 220 prior to going on insulin. This new meter and new type of insulin is supposed to be an improvement over the previous mixed insulin (Humulin 30/70). The doctor said that he hoped that it would lower my AIC by reducing my base blood sugar to 7, and cause my blood sugar to fall to 10mml within two hours of eating, after taking fast acting insulin.
He felt that the change in metering by blood sugars and changing to two different types of insulin, might result in better A1C after ninety days.
Wow! Was he surprised when he saw me after 90 days, during which I’d only had the meter and new meds for about three weeks. My AIC was down from 9.9 to 8.1. My weight was down to 234 pounds from 244. My blood pressure was stable. This represented a major change in direction. For the first time in 20 years of having diabetes my weight was going in the right direction without me having to spend a month in the hospital. My blood sugars had also dropped so that my every day blood sugar range was then 5-8 mmls routinely, with only periodic spikes up to 9 or higher.
In the past I would have been ecstatic with these results, but reading Dr. Jason Fung’s “Diabetic Code” has taught me that not only can diabetes be controlled, it can be beaten altogether. But only by following a regime that allows the liver and internal organs to cleanse themselves of internal fat, will I get rid of diabetes for myself. And that regime is intermittent fasting. As the doctor indicates in his book there are many ways to achieve the results desired by different fasts but he recommends the fasting schedule and routing I’m following.
Starting eleven days ago, I have been fasting, and following Dr. Fung’s advice. And yes, it’s been a bit of a challenge. But mostly convincing my family and friends that I’m not out of my mind and am endangering my life with such a radical change, and so quickly.
This is my fifth day of fasting, and I couldn’t be happier with my results, even after such a short period. My blood sugars have gone down and down, now typically in the target range of 5.8 to 7.8 every day. I now control my insulin, reducing the amount given to the amount needed to maintain my blood sugars in the optimal zone. On fasting days I take a 20 unit shot at midnight, and during the day watch my blood sugar coast along at 4.5. I’m almost ready to cut it again. But before I do that I think I will cut out one of my oral medications first, and set what effect this has on my sugars.
Diabetes is controllable and probably to a degree that it is no longer evident at all. But even if all I could hope to achieve was my current results, I would have been very satisfied with myself.
But I’ve just started.
So, my faithful reader, keep reading. I keep shrinking, and getting healthier.
I’m reinventing myself again. My goal is to eliminate or radically reduce prescription medications for diabetes, and a whole host of inflammatory diseases caused by the same thing that causes diabetes.
Change doesn’t come easily when one is used to surrendering autonomy to the medical profession and simply being the obedient patient. It is NOT SAFE to simply trust that doctors know what is best for us. We already know this, but it is no surprise when we obediently follow their advice. Like everything else in life, you need to check the information out for yourself, and ask a lot of questions.
It seems that diabetes is actually caused by the thing that is supposed to cure it – insulin. In his book, The Diabetes Code, Dr. Jason Fung has coined the word diabesity – combining the words diabetes with obesity, to indicate that diabesity is caused by excess glucose in the body stored as fat, particularly in the internal organs, particularly the liver. There is a cycle in the body, controlled by the liver, that triggers the production of excessive blood sugar and results in insulin resistance.
Too much sugar and the body develops insulin resistance because the body simply can’t absorb any more sugar into the cells. To make matters worse, the medical profession prescribes increased insulin, or even just metformin, which helps the body to try to consume even more sugar.
Dr. Fung’s prescription for the elimination of diabetes is contained in a book called the Diabetes Code. Read it and weep, but understand that it calls for regular fasting to reset the diabetes cycle.
This week I’m seeing my endocrinologist, and am going to be seeking support to follow Dr. Fung’s program. I’m curious as to what he will say.
Will he continue to prescribe insulin, Janumet, and Invokana to address my extreme diabetes? Or will he support a major lifestyle readjustment along with a fasting program to eliminate the disease altogether, eventually? I have already started to substantially reduce my carbohydrates and sugars in preparation for the revised program, and have already lost over 10 lbs in just under ten days.
I started writing about my diabetes and this journey several months ago, when I decided to review the prescription medications and their side effects, as a result of finally getting fed up with being sick, and seeming to get worse and worse and the years roll by.
With the encouragement of my middle son, Don, I began to look at diet as a major issue in my illnesses, as well as my diabetes. Sure, I went to many diabetes dietician clinics years ago when I first became aware that I was a diabetic. They always talked about reducing carbohydrates and sugars, and using diet and exercise to control my weight, and therefore help control my blood sugars.
As noted by Dr. Fung in his book, diet and exercise programs have been a massive failure, all over the world, in controlling or preventing diabetes or obesity. There are many reasons for this failure, but the medical professional continues to support this old and tired cant, that doesn’t actually work. I think the real reason that nobody wanted to actually examine diabetes and obesity with new eyes is that the old views are very profitable, to the pharmaceutical industry, the vegetable oil industry, even the health and diet industry itself.
But you’d have thought that somebody would have noticed that it didn’t work. And finally somebody has.
Anyway. Wish me luck on this new direction in my journey to solve my diabetes, and eliminate the side effects of so many medications by eliminating my need for them at all.
Finally, my wife Katherine has been diagnosed with Type 2 Diabetes in the past month, and has begun the journey through this ugly territory as well. Hopefully we can solve the riddle of the disease for both of us, and she never has to go through the years of pain and agony I am experiencing as a result of having poorly controlled blood sugar for the past twenty five years.
Yesterday I began a critical review of my current health situation, with a view to improve my future results by making some new decisions based on the current facts and trends.
Here is a recap of the situation as I see it now. I am taking the symptoms I listed yesterday and discussing each of them in the context of my current method of dealing with them, and/or discussing the cause of each of them as best I can, given that I’m not a doctor or scientist trained in this.
Frequent urination – especially at night, interrupting my sleep.
The whole issue of urination and bladder control is interconnected with so many of my other underlying issues so it’s probably a good place to start.
Problems with urination are a little bit like the canary in a mine that warns of trouble. One of my earliest indicators that I had a problem, (and it might be diabetes) was having a need to urinate frequently, both during the day and at night. This started in my thirties, almost thirty-five years ago.
Diagnoses of the problems with my urination were complicated by a discovery, in my thirties, that I suffer from a relatively mild form of spina bifida, which despite it not being debilitating does have some significant neurological effects on my lower body, including sexual response and bladder control. This wasn’t great news to hear when I was only in my thirties, but everything the doctor told me about the possible side effects of spinal bifida occulta has surfaced from time to time since then.
Like many other men with any problems with their genitals and urinary systems, including urination or sexual performance, I generally tried to ignore the problem as much as possible. After discussing the potential effects of the problem with my lower spinal column with the back specialist I tended to ascribe any problems to the back and nervous system, including periodic difficulties with both urination and sexual performance.
In the spring of 1985, when I was 32 years old, I also exacerbated the problem, by choosing to undergo a vasectomy, without understanding in advance that the operation could have unintended side effects. Unlike what I had expected, the operation resulted in swelling of my prostate and my testes and an infection in my urethra and bladder. For more than a year I suffered severe pain from both urination and sexual expression, and my soreness persisted for several years before fading away completely. A prescription was given to me to reduce the swelling of my prostate, but it took some time to take effect, and as it was significantly swollen, there were physical effects on both sexual function and urination.
As one might expect, given the pain, there were also emotional effects and a significant impact on my intimate life, in ways I would not have normally expected.
My reasons for having a vasectomy still seem as valid today, as they were at the time, however, part of the decision to go for it turned out to be less true than it is in most cases. My medical results included significant pain, reduced enjoyment of life, and a much higher level of anxiety about the whole subject than was probably warranted.
The argument for having a vasectomy is that it is generally considered a relatively benign surgical procedure, done in the doctor’s office as a day surgery. For a woman to have sterilization surgery is much more invasive, not to mention that it results in huge hormonal changes. My wife and I both thought a vasectomy would be less problematic, and we were probably right, despite how frustrating and painful it turned out to be.
It continues today, as so I suppose I’m used to it. However, continuing declines in muscles and nerves is also contributing to further problems, which require a certain fastidiousness to avoid embarrassment because of weakness in bladder control. It’s not promising for the future, because if it continues to decline I can see a future including adult diapers. It may be already as bad as it is going to get, at least that’s my current hope.
So my problems with sexual function and urination really started then, and it was only somewhat later that I realized that my need to urinate more frequently as I was getting old might have a relationship to diabetes.
Poor sleep – several things wake me up at night, variously including frequent urination, frequent cramps in my feet and calves, pain my shoulders and hips, dry mouth and nasal congestion, sleep apnea, hay fever, and difficulties breathing.
I’m not sure that I’m doing this analysis in the right order, but this is the order I listed my symptoms yesterday, so I will follow this list and get to the underlying stuff as it comes.
I have a lot of trouble sleeping through the night. I have a CPAP machine to help me deal with my sleep apnea, with which I have been having problems. The problems with the CPAP machine aren’t really with the machine itself, but with on again off again sinusitis that makes it almost impossible to sleep with the device forcing me to breath through my nose. So when I’m congested I don’t put it on. So it doesn’t do anything if I don’t use it.
So one of the new decisions I’m making as I do this analysis is to start using the damned CPAP every night possible. When I was using it, it did improve my blood sugars and I suppose it improved my sleep, although I didn’t feel much more rested then that I do now. In other words I’m still exhausted most days, regardless of the CPAP.
The problem with cramping in my legs and feet is another thing that wakes me up in the middle of the night fairly frequently, although not every night. When it first started up a few months ago, I asked a doctor and she advised me to use Magnesium and Calcium together to help. I started taking them every day, and my cramps in my calf muscles has been reduced to once or twice a month, instead of every night. However, this remedy has not improved the cramping in the arches of my feet, or the muscles in my toes.
Other body pain and neuropathic pain are also problematic in getting a decent night’s sleep. Arthritis and rotator cup problems wake me at various times in the night, and make it difficult to get back to sleep. Neuropathic pain which is merely irritating during daylight hours seems far more painful when I am at rest. Ergo, more interrupted sleep and more pain.
Chronic pain during waking hours – moderate to severe pain in my feet, neuropathic pain as well as mechanical distress, including pain caused by walking on supersensitive soles of my feet, as well as my toes.
I am taking Gabapentin, an anti-seizure medication which has shown to help with neuropathic pain. It may be providing me with some relief from the neuropathic pain, but the benefits are still uncertain to me. Would the neuropathic pain be worse if I were to wean off of Gabapentin, due to the numerou side effects cited in the literature?
Also… periodic moderate pain in my back and shoulders, and more serious pain in my lower back and hips when walking more that 1,000 to 2,000 steps.
Various types of chronic pain plague my waking moments, including arthritis in my hands, shoulders, hips and legs. Tendonitis has my hands bound up with pain. Inflation combines with ongoing pain.
Persistent breathing problems – mild to severe asthma on a continuing basis, almost always somewhat symptomatic but much worse when exercising or physically stressed. Sometimes exacerbated by emotional stress or conflict. Of all my symptoms my breathing problems are the most intrusive, making ordinary activities difficult or impossible. I am currently taking three separate inhalers to remediate the asthma and borderline COPD. All of them have side effects which make my sinus and throat problems worse, and while they help me breathe, they make my singing voice harsh.
Chronic physical exhaustion and fatigue – comes and goes during the day but is worse during periods of relative inactivity (sense of exhaustion) and during periods of exercise (weakness and muscle fatigue).
Addressing these symptoms is something I haven’t really been able to address, yet.
To close the blog for the day, I’ve decided to stop here and pick it again tomorrow or Friday. All of this thinking is making my head hurt, but I realize that I haven’t really given enough thought to the role of the many drugs in my system, and how their many potential side effects may be effecting me.