Month: September 2018

Sleep Writing

/ Jame A. Agapoff, MD, MS (she/they) / Leave a comment

One of the benefits of being human is that we are not solely driven by our emotions. We can act independently of our moods and even change them to better serve us.

A few days ago I was feeling particularly uninspired. As I watched the cursor blink into digital oblivion (can you feel my mood?), I thought “What the heck? I’ve been looking forward to writing this chapter all week.”

I felt like someone tossing and turning in bed but unable to sleep. If any of you know anything about sleep hygiene, you know that if you can’t sleep, you shouldn’t just lay there and ruminate, you should get up and do something else until you feel tired.

Closing my laptop, I microwaved a cup of Bengal Spice tea and sat on my meditation cushion. I also did this when I couldn’t sleep. Art being at the top of the hierarchy of needs, I reflected on why my mind might be so distracted.

Considering I was sitting on a meditation cushion with a cup of tea, I determined my physiological and safety need to be met. Also,  I wasn’t experiencing any conflicts with friends and family that might be a source of distraction. So what could it be?

As if to answer my question, the email chime on my phone sounded, and I took the bait. SPAM! Ugh! Turning off my phone, I asked myself, “What was I waiting for?”

For me, 2018 has been a year of writing action. I published several academic articles in the scientific literature and I hoped to translate that success to my fiction. Despite a barrage of queries, my work was drowning in a slush pile of submissions and I felt powerless to save it. Or was I?

So many things in life come down to perspective. I generally consider myself to be a glass-half-full kind of guy, and part of the reason for that is I set long-term goals. My recent outlook was anything but long-term. In fact, it was quite short, and the anticipation of meeting those short-term goals was affecting my focus.

Writing is, after all, a little like sleeping. It has the potential to rest and rejuvenate our minds. Good sleep hygiene begins with eliminating distractions. Writing is no different. If our minds are filled with wants and expectations, creativity cannot flow freely. When your eyes get tired of focusing on the ground, look up and rest your gaze on the limitless horizon.

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Using visualization to help actualize your writing goals.

/ Jame A. Agapoff, MD, MS (she/they) / Leave a comment

Writers face many challenges. We write, we blog, we market, we post, we wait, and on and on we go. The process is sometimes fun, sometimes tedious, and at times, downright exhausting. So how can we keep up the momentum to actualize our goals?

One method is visualization. Visualization practices have been around for thousands of years. Meditation practitioners use visualization as a means of cultivating focus and controlling emotions. Use of visualization practices has become more popular in the West in the form of guided imagery and pop psychology phenomena like the Secret (yes that book about thinking about stuff and having it come true).

Today I will teach a form of goal visualization for daily practice. It requires no previous meditation experience. All you need is an open mind. This simple process has worked for me again and again. I hope it brings you as much success.

Step 1: Visualize your goal. When I began writing fantasy fiction I wanted to finish a novel. Once I knew what my goal was, I focused on it. I visualized myself holding the completed manuscript in my hands. As I held it, I imagined what feelings I might experience at this moment: joy, or perhaps contentment. Resting in this visualization I said the following words in my mind, ‘No matter how long it takes, or what obstacles arise, I will work hard to accomplish this goal.’

Step 2: Visual the process of accomplishing your goal. When I began writing my novel, I didn’t know how long it would take or how to approach the task. If your goal is something concrete like getting into medical school, this step requires you to research the necessary steps needed to actualize your goal. Once you know this, you can begin visualizing (and planning) your process. Once you have a good idea of the process required to accomplish your goal, you can start imagining yourself doing it. This will help you build confidence for the next step.

Step 3: Engage your visualization process. Once you know the steps needed to accomplish your goal, and you have visualized a path to get there, you must act. In my case, I chose to write for 1 hour a day. To support my action, I would often preface my writing with a few minutes of visualization. First, I would visualize the finished manuscript in my hands and imagine the sense of accomplishment and contentment it would bring me. Then I would reflect on the progress, however small, I made toward accomplishing my goal. It’s important not to be self-critical at this point; instead, visual ways of improving your process. In my case, I found I wrote better in the morning than at night when I was less focused.

Step 4: Visualize past your goal. This must be done with caution. Goals are often milestones for other goals. Say publishing a novel after writing it. Visualized goals should be big with defined steps, but not so big that they paralyze us into inaction. Also, don’t mistake fantasy for visualization. A fantasy is an escape. Visualization is a tool. I can derive a certain amount of momentary contentment fantasizing about what it would be like to be a famous author, but a fantasy offers no path of accomplishment. Only visualizations can do this. So dream big, plan well, and when you see the end of the tunnel, see past it.

The Secret Costs of Writing

/ Jame A. Agapoff, MD, MS (she/they) / Leave a comment

When I began my first novel I had a romantic view of the publication process. I imagined it would go something like this: step 1 finish the novel; step 2 edit the novel; step 3 submit the novel for publication; step 4 sign publication deal; step 5 engage in publisher supported signings, social media, and events. If you’re laughing, you probably have tried to get something published yourself. So what is the process actually like?

After you ‘finish’ your novel, the first thing to ask yourself is whether or not it’s actually finished. Case in point. The first edit of my fantasy novel was 160,000 words. After doing a little research, I learned that unless you are an established writer, the chance of getting anything over 120,000 words published is slim to nil.

After I reached 120,000 words; sigh, I jumped right into looking for publishers. I found out very quickly that only a few publishing houses accept unsolicited submissions. Reading through their submission guidelines, I also learned that they don’t just want the manuscript to be finished–they wanted it polished to perfection.

If any of you have ever looked for a book editor, you will probably agree with the following points. First, there are a lot of them out there. Second, prices vary widely. Third, sometimes it’s hard to tell who is good from bad.

In my case, the first copyeditor I chose was a disaster. I basically got ripped off. 😦 This was partially my mistake for not asking for a sample edit. Learning from my mistake, I got a sample edit from the next copyeditor I considered. I’m glad I did because as I reviewed the sample edit of my work I could tell that the editor was not familiar with my genre and we did not connect. 😦 The third copyeditor I got a sample edit from turned out to be the one. 🙂 She understood my genre, her feedback was constructive, comprehensive and helpful, and her cost was market average.

When I finally found a good editor, I elected for two services: copyediting and proofreading. Copyediting is basically an independent revision of your work. Personally, I found the process enlightening and helpful. Proofreading addresses minor errors and makes sure the piece is ready for publication.

In the process of beautifying my novel, my publication journey yielded another realization: traditional publication is almost impossible without an agent. Okay, so I need an agent. How hard can that be?

Querying agents is an onerous process. It is akin to a complex courting ritual that is rarely successful. Ritual items include query letters, bios, sample pages, short and long synopsis, reading lists, favorite color (well maybe not that). Once you submit your materials you wait… Sometimes you hear nothing and other times, usually, after weeks of waiting, you receive the standard rejection letter pointing out the subjectiveness of the industry. That little tidbit has never made me feel better.

At some point during this process, as our manuscript is collecting dust, many writers begin to feel the itch to self-publish. True, some people sit on novels for years before they eventually get traditionally published, but waiting, editing, and querying until your fingers are sore is no guarantee of success. Neither is self-publication a guarantee of an audience or success.

Ultimately, success comes down to the work and how you market it. When I started writing, I focused on the work and did not put any time into social media. Personally, I think this could have helped me attract an agent (I am still trying). Agents being risk-averse, I get the sense that most are looking for proven products with established platforms. Honestly, I can’t blame them for playing the odds game.

Self-Publishing is also complicated. Individuals can use platforms like Amazon to epublish their work with little overhead. There are a number of boutique presses out there that offer a variety of services from editing to marketing and publishing. These services can run anywhere from a few hundred dollars to many thousands of dollars.  If you have the money and believe in your work, this may not be a bad idea.

As a physician, I can honestly say that getting a novel traditionally published may be more difficult than getting into medical school. Whether or not I choose to self-publish is still up in the air. If I do, and the work becomes successful, I imagine I will have agents contacting me. If that happens, I hope those agents who didn’t offer me representation don’t have a change of heart. You had your chance.

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Phytoestrogens in foods: Are they safe?

/ Jame A. Agapoff, MD, MS (she/they) / Leave a comment

This post is in response to a reply I received on my recent post Tofu or Not to Tofu where I highlight some of the recent evidence linking long-term consumption of tofu with cognitive decline. The author of the comment took issue with the comparison between estrogens and phytoestrogens. I personally do not believe arguing openly online is appropriate,  so in an effort to be kind, I have deleted the comment but will respond to the content of it.

“Phytoestrogen and mammalian estrogen are completely different.”

Answer: Yes and No. The structure of mammalian estrogen and plant estrogens are different if compared molecule for molecule; however, looking at the structures you can see the similarities between the two compounds. In biochemistry, structure equals function, and phytoestrogens can activate mammalian estrogen receptors in the same way as endogenous estrogen.

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Photo Credit: https://www.superfoodly.com/estrogen-foods-list-50-high-phytoestrogen-sources/

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Image Credit: http://rexflavone.com/phytoestrogens/

“Phytoestrogen is not in any way a threat to human health the way estrogen is, because the human body does different things with them (since they are different compounds after all).

“Phytoestrogen is not a sex hormone from a mammal, which estrogen is; so when consumed we don’t increase risk of the cancers, heart disease, diabetes, hormonal problems, weight problems, digestion problems, or skin problems that we do when consuming estrogen.”

There are several problems with the statement above. Stating that phytoestrogens are “not in any way a threat to human health,” ignores the evidence of a link between phytoestrogens and memory decline as referenced in my previous post. It also fails to acknowledge the varied and often conflicting human clinical studies addressing not only the safety and but also the efficacy of phytoestrogens in a wide range of conditions.

The commenter above claims that because phytoestrogens are not endogenous sex hormones they don’t increase risk of “cancers, heart disease, diabetes, hormonal problems, weight problems, digestion problems, or skin problems.”

So what does the peer-reviewed scientific literature say?

In a more recent review of the scientific literature on phytoestrogens, Sirotkin and Harrath, address some of the many potential benefits and risks of dietary phytoestrogens. Let’s take this point by point.

Cancer. The soy isoflavone genistein has been shown to have anti-cancer properties in animal models. Population studies in Japan and China imply a lower incidence of prostate and breast cancers in eaters of traditional soy products. There is also evidence that soy isoflavones may help prevent colon, endometrial, and ovarian cancers. The studies surrounding breast cancer and phytoestrogens with some studies implying safety, others not, and many being equivocal.

Heart Disease. Cell and population studies demonstrate that phytoestrogens may be protective against cardiovascular disease through a variety of mechanisms. Unlike natural estrogens, phytoestrogens are also less likely to contribute to blood clots.  Despite these promising findings, clinical studies that involve human subjects have failed to demonstrate any appreciable effects on arteriosclerosis and other cardiovascular diseases.

Diabetes and Obesity. The isoflavone genistein (the primary phytoestrogen in soy) has been shown to stimulate replication of pancreatic beta cells in cell studies, which are lost in diabetes. Genistein has also been shown to influence the life cycle of the fat cell and inhibit inflammation and oxidative stress associated with obesity. Both long and short-term human studies have shown conflicting results with most authors unable to make definitive claims or recommendations. As Talaei and Pan conclude, “Although the widespread use of phytoestrogens could not be recommended due to the controversies, habitual consumption of phytoestrogens, particularly their intact food sources like soy and whole flaxseed, could be considered as a component of an overall healthy dietary pattern for prevention and management of T2D.”

Skin. Phytoestrogens like estrogen exert an anti-aging effect on the skin through the estrogen receptor. Human studies comparing oral and topical formulations of the isoflavone genistein with estrogen have been promising with results implying increased dermal thickness, better vasculature and decreased fine lines in both groups. Of note, topical formulations of phytoestrogens did not demonstrate body-wide effects, which could have deleterious effects.

Digestion. Phytoestrogens in combination with probiotics are hypothesized to increase the production of the biochemicals equol, enterolignans, and urolithins, which are considered protective against chronic diseases related to aging. Human studies supporting these benefits are lacking.

Conclusions. Any compound whether natural or endogenous has the potential to produce a wide range of effects on human health and physiology. Natural does not always mean safe or better. All of us must be cautious when choosing what we put into our bodies whether it is a supplement or a food. The potential benefits of specific phytoestrogens for human health are interesting and encouraging. Given the evidence as it stands today, I personally could not recommend consumption of supplements or products high in phytoestrogens. Be wise. Be informed. And above all, be kind.

References:

Sirotkin, Alexander V., and Abdel Halim Harrath. “Phytoestrogens and their effects.” European journal of pharmacology 741 (2014): 230-236.

Talaei, Mohammad, and An Pan. “Role of phytoestrogens in prevention and management of type 2 diabetes.” World journal of diabetes 6.2 (2015): 271.

Irrera, Natasha, et al. “Dietary management of skin health: The role of genistein.” Nutrients 9.6 (2017): 622.

Landete, José María, et al. “Probiotic Bacteria for Healthier Aging: Immunomodulation and Metabolism of Phytoestrogens.” BioMed research international 2017 (2017).

 

To Tofu or Not to Tofu?

/ Jame A. Agapoff, MD, MS (she/they) / Leave a comment

As a nutritionist, physician, psychiatrist, soldier, and writer, I’m always looking for ways to improve my physical and mental stamina through diet and exercise. Ten years ago, I chose to adopt a vegetarian diet for ethical, ecological, and nutritional purposes. As I acclimated to new dietary sources of protein like egg whites, beans and rice, and soy, I came to enjoy the versatility and flavor of tofu.

Tofu is one of many soy products that have become popular in the West. It is a fermented form of soy, which makes it different than other soybeans products. Tofu has long been a cornerstone of many Asian diets. But is it safe?

There is a growing body of evidence that tofu consumption is associated with poor cognitive outcomes as we age. The Honolulu-Asia Aging Study was one of the first studies to report increased risk for cognitive impairment and other dementia markers with high tofu intake. Studies in Indonesia, China, and other Asian countries have confirmed these findings. So why might tofu cause memory decline and not other soy products?

The short answer is phytoestrogens. When tofu is fermented, phytoestrogens are created. Phytoestrogens can exert effects on estrogen receptors. Estrogen has been found to increase dementia risk in women over 65 years of age. Both Tofu and Tempe contain high levels of phytoestrogens.

As is the case with most things in life, moderation is key. Periodic consumption of tofu is likely not to have a substantial risk on cognitive status. That being said, if you’re a vegetarian like me, you may wanna skip the tofu.

References:

P Gelber, Rebecca, Lenore J Launer, and Lon R White. “The Honolulu-Asia Aging Study: epidemiologic and neuropathologic research on cognitive impairment.” Current Alzheimer Research 9.6 (2012): 664-672.

Hogervorst, E., et al. “High tofu intake is associated with worse memory in elderly Indonesian men and women.” Dementia and geriatric cognitive disorders 26.1 (2008): 50-57.

Xu, Xin, et al. “Tofu intake is associated with poor cognitive performance among community-dwelling elderly in China.” Journal of Alzheimer’s Disease 43.2 (2015): 669-675.

 

 

 

The Challenges of Writing Goals

/ Jame A. Agapoff, MD, MS (she/they) / Leave a comment

Part of being an effective writer is setting writing goals. Sometimes we are afraid to set goals because we don’t want to fail them. Goals are not about failure or success; they are about progress. Listed below are 4 tips to help make your writing goals work for you.

  • Create short-term and long-term writing goals
    • I set monthly and yearly writing goals for myself. Yearly writing goals can be BIG, i.e. ‘finish my novel,’ ‘publish my meditation book,’ ‘complete four academic publications.’  Short-term goals can be very specific. ‘I will finish 3 novel chapters this week,’ ‘I will publish two blog posts every weekend this month.’ Once the day, week, month or year is over, objectively (and without judgment) evaluate your progress and modify your goals accordingly.
  • Diversify your writing goals over more than one project
    • I typically have 4-5 writing projects at any given time. I find that my motivation and inspiration vary from project-to-project depending on the day. Having several projects helps me stay engaged and make progress toward my writing goals even when the muses seem to have abandoned me.
  • Allow your writing goals to be moving targets
    • I like to set big goals. Sometimes I achieve them. Sometimes I don’t. Sometimes no matter how hard I work, certain writing goals continue to elude me. I recently met an author who finished a novel 8 years ago and is still revising it for publication. In her case, the target goal moved with each revision. Instead of viewing this as a negative experience, the author remarked how her revisions improved her work. Remember, goals are not about success or failure but progress.
  • Be flexible 
    • As much as I try to keep personal emotion aside, it’s hard not to get frustrated when I don’t meet my writing goals. Frustration and anger have never served me as a writer. Anger produces many cognitive distortions like magnifying the negative aspects of a situation, blaming others, and catastrophizing future outcomes. I have come to accept that my writing isn’t perfect even when it’s published. Accepting this fact, I’m less hurt by rejection and more flexible in adjusting current and future project goals.

Minimalism and Writing

/ Jame A. Agapoff, MD, MS (she/they) / Leave a comment

What you want will probably not bring you happiness. That’s one of the key messages in the documentary Minimalism: A Documentary about the Important Things available on Netflix. In the film, stars and authors Joshua Fields Milburn and Ryan Nicodemus explore the deficits of a modern material culture and how having less may ultimately lead to happiness and better relationships.

As many of us move out of college into our careers, we are thrust into a material culture that places pressures on us to accumulate things. Our lives become increasingly complicated and focused on work at the expense of family, and, dare I say, creativity. Many of us lose ourselves in the pursuit of riches and the act of appropriation, which never fulfills our basic need for belonging and meaning.

In his 1943 paper, “A Theory of Human Motivation,” Abraham Maslow proposed a set of needs that humans are motivated to achieve (see image below). As one’s physical needs are met, he/she moves up the pyramid to psychological needs and then to self-actualization and self-transcendental needs. Self-actualization/transcendental needs include creative projects like writing and spiritual endeavors.

In the U.S. today, we have achieved a standard of living unheard of in the history of civilization. Despite this, many people are not happy and lack a sense of purpose. Using Maslow’s framework, one could argue that our modern materialist culture has promised self-actualization through an accumulation of status and possessions and left us empty and desiring more, more, more.

For myself, writing fills this existential void. What is profound about the application of minimalism is that it supplants the materialistic schema telling our brains that more things equal more happiness. Once this schema is removed, self-actualization again becomes achievable through self-improvement, art, and spiritual pursuits.

I’m not sure if I am cut out to be a true minimalist; however, I do believe in the idea of quality over quantity; that the best things come in small packages; and you can’t buy true happiness.

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Image Credit:

https://www.simplypsychology.org/maslow.html

Food for Writing, Food for Life: Walnuts and Omega 3’s

/ Jame A. Agapoff, MD, MS (she/they) / Leave a comment

Before I finished my medical degree, I completed a master’s in nutrition at the Institute of Human Nutrition, a division of Columbia’s College of Physicians and Surgeons. During my time at the Institute, I focused my personal research on the topics of anti-aging, brain nutrition, and plant-based diets. We are what we eat, and what we eat can dramatically influence our energy, concentration, memory, and creative abilities.

For most of us who write in our free time, there is not enough day in the day. Our work, families, and other responsibilities are always jockeying for our attention. Sometimes, the temptation to do anything but writing can be very strong. That said, there are foods that can improve your mental and physical stamina over time. Today’s topic is on Walnuts and Omega 3’s.

You may notice the variety of nuts offered in the baking aisle.  The nutritional quality of nuts varies widely (see below). When looking at a table like this it is important to note that “poly” unsaturated fats are considered (in general) healthier than “mono” unsaturated fats or saturated fats (worst). As the chart shows, walnuts have the greatest compliment of polyunsaturated fats and these occur in the form of ω-3 (Omega-3) polyunsaturated fatty acids (PUFAs).

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Image Credit: https://navs-online.org/articles/nuts-seeds/

ω-3 (Omega-3) polyunsaturated fatty acids (PUFAs) come in many forms. When you look at the back of a bottle of fish, algae, krill, or flaxseed oil, you will see the ω-3’s broken down into ALA (α-Linolenic acid) vs. EPA (Eicosapentaenoic acid) vs. DHA (Docosahexaenoic acid). You may note that in many vegetarian sources of ω-3’s like chia seeds, WALNUTS, and flaxseed oil, the ω-3’s occur almost exclusively in the form of ALA.

Now the sad truth: your body has a hard time using ALA, and the conversion rate in the body from ALA to EPA and DHA is less than 1% according to some sources. ALA may be considered a source of energy, but that is doctor code for saying it’s just a source of calories.

So is it pointless to eat rich sources of ALA? Probably not. ALA is a polyunsaturated fatty acid and is, therefore, healthier than eating animal-based saturated fats. Classically, a diet rich in polyunsaturated fats is considered to have a cholesterol-lowering effect.

DHA and EPA are the active ω-3’s in the body. I recommend everyone read the article by Dr. Barry Sears in Psychology Today (see reference link below) to see the potential benefits of DHA vs. EPA. EPA is the more active molecule biologically and accounts for a majority of Omega 3’s beneficial anti-inflammatory effects. Sadly, the richest sources of DHA and EPA are from non-sustainable sources like fish and krill oil (whale food); however, for vegetarians like me, Algae Oil is a rich source of both EPA and DHA. Yay, modern science!

Eating a rich complement of functional foods like walnuts can decrease body-wide inflammation and improve your potential to be creative. The more we think about what we eat, the greater impact we have on our own health, the health of others, and the health of the planet.

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Image Credit: https://phoebemd.com/2017/03/14/guide-to-omega-3-fatty-acids-foods/

References:

Sears, Barry. (2012) “What Are the Real Differences Between EPA and DHA? To reduce cellular inflammation, you need more EPA than DHA.”  https://www.psychologytoday.com/us/blog/in-the-zone/201204/what-are-the-real-differences-between-epa-and-dha