Sunday, December 27, 2009

The Mindfulness and Acceptance Workbook for Depression


I began reading this book with the cynical expectation of being brainwashed by ACT (acceptance and commitment therapy). I relaxed some when in the middle of the book I read, “The type of acceptance we encourage you to practice is best thought of as a voluntary, intentional stance of nonjudgmental awareness of thoughts, feelings, memories, and sensations in the context of a triggering event.” By the end of the review, I absolutely loved the book. But I am quite certain I wasn’t brainwashed. Instead, I think it was the large focus on mindfulness with lots of engaging exercises that won me over.

The authors use a comprehensive definition of health that includes physical, psychological, and social aspects. The text itself is interesting in that it contains elements of ignorance, intelligence, poetry, insightfulness, creativity, superiority, and flaky triviality.

In the foreword the authors claim that, “Depression is not just a feeling. Depression is an action.” I would argue that depression is much more than either or both of those things. However, depression does affect action and action can likewise affect depression so both need to be ‘treated’ (by treating actions I mean learning healthy new behaviours and coping strategies).

There is a lot of talk of avoidance (presumably in order to contrast acceptance) of issues as being a root problem for depression. It is not uncommon for people with depression to avoid certain problems, but it is also common for depressed persons to be actively seeking solutions, only their illness clouds effectiveness. People with depression do try.

The ideas, at least in the first half of the book, are quite dichotomous. The book only has two options for thinking processes – wise mind and reactive mind – whereas I am more familiar with the three option approach – emotional mind, reasonable mind, and wise mind, which is a combination of the former two. There was actually a sentence at the end of a chapter implying that if the reader wasn’t ready to commit to change, they shouldn’t read any further until they are. I encourage readers to continue regardless as there are some beneficial exercises.

Many of the exercises in the book were insightful. I particularly liked the one where you get to write your own epitaph – “I should have separated the whites.” This type of individual engagement with understanding problems and solutions is likely to be more effective than simple fill-in-the-chart exercises.

It’s refreshing to see CBT ideas translated with a different vocabulary. An example of this is the ‘phishing’ metaphor used to help the reader identify problematic thinking. In CBT these same thinking types are recognised as ‘mind reading,’ ‘all or nothing thinking,’ etc. Plus, bonus points for using a computer metaphor leaning on the geeky side.


Final Rating: Very good.

Sunday, December 13, 2009

Heat Therapy




Heat is often used to treat pain associated with muscles and bones, but there doesn’t seem to be much research as to the psychological effects of thermal treatments. Undoubtedly though, warmth engenders anxiolytic effects. (An interesting note, heat therapy is commonly advertised as a treatment for anxiety, among other things, in dogs.)

One study directly related to the measure of psychiatric symptoms, found that people with mild depression who were exposed to thermal treatment (sauna and warm blanket in a warm room) had a greater reduction in psychological and physical symptoms (including appetite) than a control group.

In a 2008 study, researchers found that, based on the hypothesis that the insula is involved in processing both physical and psychical warmth, exposure to warm objects increased interpersonal warmness (generous, caring). The study design itself is quite amusing.

Other studies (1, 2) have found warm baths before bedtime reduced insomia and improved sleep in older adults and the elderly, respectively.

Suggestions on ways to warm up: sauna, bath, pocket packs, trip to the tropics, electric or regular fireplace, electric blanket, warm drink.

Things to be cautious of: burns, overheating/hyperthermia, dehydration.

It would be curious to see if a combination of heat and light therapy, such as in a tanning booth (you can wear sunscreen) had some adjunctive effect.

Thursday, December 10, 2009

Gifts for Someone Who is Depressed




This could be for the holidays or a special occasion or just because. The best gift is your support, but presents are nice too. The following list is compiled from ideas I found on the interweb and my own ideas. There are of course many wonderful gifts you could give to any person, but I tried to make this more specific for depressed people by choosing gifts that are not only presents, but will enhance their life in a healthy and positive way.

* Ask them to do something healthy for you -bake a cake, make a cd, play a song if they play an instrument. Some people might be more willing to engage in activity if they’re not concerned about the cost/benefit to themselves. Eventually, an individual has to choose to things by and for themselves, but a little help getting started can go a long way.

* Make them some homemade food. Self-care can be difficult when depressed and appetite particularly can fluctuate. Having nutritious, wholesome, and comforting food at hand can make the difference between a person eating or not.

* Pretty paper or a nice journal. There can be a lot of CBT homework and scheduling; having some brightly coloured paper might encourage someone to fill out their 3 positive events for that day, for example.

* A day out. Ask them to go for a walk with you. Take them to a movie or concert. Bear in mind, they might not be in their best mood. So don’t necessarily expect the outing to be overly joyous, but do know that even if it seems you are only helping a small amount, that amount can be greater to your guest. In short, don’t put expectations on them to respond in a particular way.

* A plant or pet. Things like pets you need to be careful with; they might not have the energy to train a puppy. Something like a Siamese fighting fish might be more appropriate. Sometimes when a person is depressed they can be resistant to caring for another person/thing. If the gift dies, don’t be angry. Offer whatever emotional support they need to take care of this new thing; it might seem a simple skill, but even the easy stuff gets difficult in difficult times.

* Something comforting such as a blanket, stuffed animal, new socks, or hot chocolate packages.

* A picture (or pictures) of them by themselves or with someone else doing something memorable. It’s easy to forget that you were ever happy when you’re depressed.

* Money, gift cards, or offer to pay bills. That alone can alleviate a lot of stress.

* Adopt a child or endangered animal in their name. Encourage them to write letters to the child or stay updated with conservation through the newsletters that are mailed to sponsors.

* Enroll them in a class. Exercise is extremely good and an activity like yoga could help with mindfulness while they exercise. But any class (cooking, academic) that encourages social activity and skill building is good.

* A book. But a positive book, not one with a sad story and a sad ending. Self-help books are also an option, but these can be personal. Give them the opportunity to tell you it’s not quite the right book, but they would like something similar.
Garth Kroeker has a good reading list.


* Music. This can be given either as a cd/mp3 or an instrument. I recommend Glenn Gould’s 1955 recording of the Goldberg Variations.

* A light box. Very helpful for seasonal as well as chronic depression.

* A comedic dvd or cd.

It might sound cynical, but when giving a gift that involves the receiver and another person, be sure they like that other person. The thought always counts, and they will most likely appreciate the gesture, but it’s also nice to have something tangible. I don’t mean this to sound materialistic, most of the above suggestions can be done at little cost, only that concrete reminders of healthy times/relationships can last longer than thoughts which can become easily distorted or forgotten by the depression. The other option is to let them choose their companion (for example, give them two movie tickets, but don’t suggest they have to take you. Do encourage them however, to take someone. Adding a social activity to a pleasurable one can make it that much better.).

*** Avoid things like alcohol

* This site has some humourous gifts, but exercise caution when practicing irony.

Friday, December 4, 2009

Psychiatry Blog Novels

I’ve been trying to put together a collection of blog novels directly related to psychiatry. Unfortunately, my ability to use a search engine is embarrassing and so far I’ve only found two such books. But I know there must be more, so if anyone has any suggestions, please feel free to comment.

1. ‘The Goose That Laid the Golden Egg’ a Twitter novel about a psychiatrist who takes on a multibillion dollar drug co and finds his mother along the way.


2. ‘In the Absence of White Rabbits’ examines in great detail one woman's relationship with her psychosis, psychiatrist, and imaginary friends.

Monday, November 23, 2009

Cat Ownership Metaphor


Like emotions, when a cat’s needs aren’t being met, they will let you know. This desperate attempt at communicating may be quite unpleasant, as cats (emotions) have a limited capacity for communicating with their owners. You may be clawed at, jumped on, or left with copious amounts of bodily fluids on your living room floor.

The important thing to remember is that your cat is not doing these things simply to aggravate you. They are just trying to let you know something isn’t working for them. Also like emotions, cats can not be ignored (one person, literally, suggested the option of putting a cat down if they had become a nuisance, which I vehemently disagreed with, literally and metaphorically). You have to live with them.

You might be able to take a brief reprieve by putting the cat outside or in another room for awhile (this could refer to any distress tolerance techniques), but eventually they will scratch at the door demanding to be let back into your company.

On the positive side of this metaphor, cats can be very tender, loving, warm, and playful companions.

However, in order for felines to function in full capacity, one needs to figure out the specific favour being requested. In the literal sense, this might be accomplished through any type of therapy or personal introspection.

If the issue has been left for too long before being attended to, the work in remedying the situation (cleaning up the copious amounts of bodily fluids) can be unpleasant. And one can easily become disgruntled if after cleaning up a mess, the cat repeats the same unwanted behaviour (this might mean one has tried a particular coping strategy, and found it successful, only to have their original issue resurface). But all this means is that more work needs to be done in identifying the problem. It could also mean that the problem has been identified, but the remedy is a process rather than a one time fix (such as if the cat had a bladder infection and required medicine for a few weeks).

If ‘owned’ in a healthy manner, cats will function in a likewise manner. This is not to say they will always behave perfectly, as feline temperaments are subject to situational changes (literally this might be any non-constant stressor such as getting a flat tire during rush hour, etc.), but that they will behave appropriately in stressful situations (instead of urinating on your laundry, they may meow outside of their litter box to let you know it’s time to clean it. A person who has a flat tire may call BCAA instead of getting angry).

And sometimes a cat just needs to be, gently but sternly, taught what the rules are (setting boundaries on your emotions and behaviours).

All in all, when properly tended to, living with cats is an extremely enjoyable experience.

Sunday, November 22, 2009

Vitamin Water Update

Original Post Here.


I have received quite a bit of varying information with these drinks. Of course, when dealing with percent daily values there is going to be some fluctuation in recorded measurements. There is also likely to be some variation between flavours.


For this chart, I have physically looked at the labels for Jones 24C, Aqaufina +, and Glaceau and calculated the percent values myself (Jones 24C is a new addition to the chart).


Life Water

Dasani Plus

Aquafina Alive

Aquafina +

Glacéau

Jones 24C

Coke

Calories

100

0

0

120

120

**

110

Fat

0

0

0

0

0

Sodium

87.5

62.5

162.5

0

30

Total Carbs

25

2.5

0

32.5

30

Sugar

25

0

0

30

0*

Fiber

0

2.5

0

0

Vitamin A

50

300

Vitamin C

100

100

250

150

400

Vitamin E

20

10

10

80

50

75

Vitamin B3

10

10

50

25

30

70

Vitamin B5

85

40

40

Vitamin B6

10

10

50

35

25

250

Vitamin B12

10

10

40

25

500


Personally, I think Jones has gone a bit overboard; there are risks to consuming too much Vitamin B. And I am quite certain I recorded those numbers correctly, but I feel that something must be off somewhere.



I maintain my previous belief that vitamins come best without sugar, are cheaper as supplements, and tastier as food.

Thursday, November 19, 2009

Sexy MRIs


Call me a physics geek, but when I learned I was going to be introduced to an MRI machine, I was already giddy. When I finally did meet the object of my amorous affection, it tried to undress me (big magnet plus metal clasps on bra and shirt equals considerable excitement). I thought my love for this massive magnetic force had been consummated the day I went inside of it (it even required me to remove my birth control), but it turns out there are people luckier than me out there.

A 1999 study done by a group of researchers in Holland (Pek van Andel won the Nobel Prize for this work), aimed to examine the anatomy of genitals during intercourse. The second objective, and the one most deserving of funding, was simple curiosity, “To find out whether taking images of the male and female genitals during coitus is feasible…”

The study design was quite interesting. There is an interesting figure in the paper – a sketch drawn by Leonardo da Vinci depicting the anatomy and coital details of intercourse. There are also of course, actual images obtained from the experiment.

There is also a video available.

Saturday, November 14, 2009

Holiday Survival Guide


The holidays can be a particularly lonely time for people. Even for those who look forward to the holidays, they can still be overwhelming. The following is a list of some things that may be helpful.

* Create/buy an especially thoughtful gift for someone who has supported or helped you.

* Do the above for someone random- a person on the street, pick an address from the phone book, or a needy family.

* Donate to charity. Clean out your closet and give what you don’t need to a local shelter.

* Volunteer. Help out in soup kitchens or with the red cross. Spend time with the elderly who might not have family visiting.

* Breathe. Holidays are chaotic and you may be forced to spend time in the company of people you dislike. Take time for yourself. Leave the party to go for a quiet walk. Find an empty room where you can read a book for a while. Sit in your car and listen to music for a few minutes.

* Be nice to people you don’t like.

* Host a dinner for a few people you are close to. Cooking for other people can be very therapeutic (in my case, this oftentimes leads to food poisoning, but the activity of cooking and sharing is still a positive event).

* Take a trip. I don’t encourage people to avoid difficulties, but sometimes you need a break so why not take that trip to Paris during the holidays?

* Exercise. This is something I always recommend, but the holidays can be especially lethargic times so it is important to maintain your exercise regime. Going for a run can also get you of a crowded, or empty, house.

* Make sure you have enough medication if your doctor will be taking time off.

* Remember, you don’t have to listen to Christmas music. At times this may be unavoidable, but in your home you can listen to whatever you like, even on Christmas morning. Some people may weary of the holiday music that is played in stores as early as November 1, so listen to your ipod while shopping.

* Do not feel obligated to anyone to do anything.

* Avoid alcohol.

* Eat nutritious foods as well as the delicious ones. And eat in moderation.

* If people start bickering, say something nice about them or someone they are talking about.

* Accept gifts graciously.

* Keep an emergency plan in place. Know where the hospital is if you’re out of town. Keep a list of friend’s numbers or call lines.

* Don’t abandon your regular activities. Keep doing all the things you normally do to stay healthy.

Sunday, November 8, 2009

Emotion Regulation Homework Sheet 1 : Observing and Describing Emotions - Revised

The revised worksheet can be downloaded here.

What follows is an adaptation of an exercise taken from the Skills Training Manual for Treating Borderline Personality Disorder by Marsha Linehan. The skills in this book, as well as any other CBT or DBT book, are not limited to BPD nor are they limited to people suffering from any disorder, but are useful to all people.

My problem with most of this type of homework is that it tends to focus on negative emotions. It is of course important to understand these, but it as at least as important to recognise the positive ones. Even in a deep depression, there will be moments when things aren’t as bad, even if it only lasts a moment. But depression makes it difficult to remember these moments, which is why I think it is important to reinforce them by documenting them (just saying happy words can alleviate some symptoms, even if you don’t believe in them).

So I am beginning a series of revisions to common homework worksheets that encourage the recognition of positive emotions and events as well as challenging the negative ones. There is nothing really new in terms of techniques in these adaptations, but rather they incorporate different exercises into a more complete, and I think beneficial, exercise.

It is best to complete this form when the emotion was recent so that you can record in more detail.

Also, very importantly, for every negative emotion that you complete one of these sheets for, do at least one other for a positive emotion. This will not only reinforce healthy thinking, but will also help you when planning for future negative emotions (for example, you may fill out a sheet for feeling worthless and another day have an experience of feeling worthwhile. You can then use your physical, emotional, and behavioural reactions to the positive situation to revise how you might change these things when experience worthlessness again. E.g. when feeling worthless your shoulders were slumped, but when feeling worthwhile you were standing straight. You can then go back and make sure that changing your posture to sitting up when feeling worthless is on your list of physical changes to make).

Related to the above parenthesis, you may find these sheets useful for compiling a list of warning signs and coping strategies.

Friday, November 6, 2009

Mindfulness in Elementary Schools


Not to be too cynical, but with all the programs that have been and are being cut, I sometimes wonder if there is any reason to send a child to school anymore.

But, on the bright side, people are beginning to understand that character development mostly happens during the developmental years and if we would like to prevent future mental illness, this is period of time to act.

Mindfulness isn’t prevalent in the school curriculum, but it is growing. This paper discusses the mindfulness program at a school in Los Angeles.

“There was less conflict on the playground, less test anxiety—just the way the kids walked into the classroom was different. Our state test scores also went up that year, which I’d like to attribute to my teaching but I think had more to do with the breathing
they did right before they took the test.”

“…many schools are adopting mindfulness trainings because the techniques are easy to learn and can help children become ‘more responsive and less reactive, more focused and less distracted, [and] more calm and less stressed.’ While mindfulness can produce internal benefits to kids, the Garrison report also found that it can create a more positive learning environment, where kids are primed to pay attention.”

Locally, psychologist Kimberly Schonert-Reichl recently finished a pilot project on
mindfulness in six Vancouver schools with positive results (which is also discussed in the same publication).

“…results also showed that these children were less aggressive, less oppositional toward teachers, and more attentive in class. Those who received the mindfulness training also reported feeling more positive emotion and optimism, and seemed more introspective than children who were on a waitlist for the training.”

The project site for this research can be found here.

Wednesday, November 4, 2009

Musicophilia – A Review

No one can say that Oliver Sacks doesn’t have an extensive collection of strange stories. As interesting as these stories can be though, I find his narrative to be redundant. While the anecdotes may drone on, there is interesting information in his tangents and footnotes.

The book discusses the effects and involvement of music in many psychiatric and neurological cases. A chapter is devoted to music therapy for speech and movement, especially with autism, and the importance of a connection between the musical therapist and the patient.

Sacks at one point cites Nietzsche and his philosophy on physiological and psychological effects of music (other notable people discussed include Darwin and Freud).

There is mention of an interesting use of botulinum toxin in the treatment of musical dystonia, a condition which appears to affect a particular body part, most often the fingers, only when an instrument is being played. The effects of the treatment are limited though:

“Such injections-though not always effective-have enabled some musicians to resume playing their instruments, [but] it may be unwise…to attempt a return to performance.”

The book discusses both the loss of music, in either functionality or appreciation, and the gain of music, as in the composition of large works while dreaming.

Final Rating: A good afternoon book of which you don’t necessarily have to read every page and which is a good source for further research into the areas of music and neurology.

Saturday, October 31, 2009

Graduate Studies


There was a very interesting article, The Ph.D. Problem, in Harvard Magazine detailing many of the problems in the pursuit of higher academic education. The content of the essay is disheartening, though not unrealistic.

While I remain cynical where politics of academia are concerned, research is an absolute necessity. This article focuses on the area of humanities, but general complaints (length of degree, job security, overspecialisation, exclusivity) about the process of graduate education could be applied to other departments.

“…if doctoral education in English were a cartoon character, then about 30 years ago, it zoomed straight off a cliff, went into a terrifying fall, grabbed a branch on the way down, and has been clinging to that branch ever since…the result of this is a kind of normalization of what in any other context would seem to be a plainly inefficient and intolerable process.”

(I actually think this is a metaphor that can be applied to chronic mental illnesses where unhealthy living is accepted because the normality of the distribution of life events has been shifted due to stagnation.)

“An estimate of the total elapsed time from college graduation to tenure [in humanities] would be somewhere between 15 and 20 years. It is a lengthy apprenticeship.”

“Job satisfaction is actually higher among Ph.D.s with non-academic careers than it is among academics, partly because spousal problems—commuting marriages—are not as great outside academia.”

“…there is a huge social inefficiency in taking people of high intelligence and devoting resources to training them in programs that half will never complete and for jobs that most will not get.”

Wednesday, October 28, 2009

External Validation


"Self-esteem is the greatest sickness known to man or woman because it's conditional."--Albert Ellis, Ph.D.

If you google external validation, you come up with a lot of hits asserting it’s a bad thing. Or at the very least, it’s not as good as ‘self-esteem’.

Nathaniel Branden, a psychotherapist who received his Ph.D in the 70’s, called external validation "pseudo self-esteem." He made the common argument of "true self-esteem" being derived from internal sources, such as self-responsibility and self-sufficiency. He defined true self-esteem as "...the experience of being competent to cope with the basic challenges of life and being worthy of happiness". (1)

Yet external validation is something children need. Adults with mental health problems (most famously, borderline personality disorder) may not have been nurtured in that area when they were children, or even as adults, and so might need such validation in their adult years.

External validation may be necessary in the development of self-esteem; Encouragement and approval most definitely do aid in building self-esteem traits.
Linehan, the famous validator, proposed six levels of validation: listening nonjudgmentally, accurate reflection, mind-reading, or articulating unspoken thoughts and feelings, understanding the historical background of a behaviour, confirming thoughts, behaviours and feelings based on current circumstances and radical genuineness, which requires the therapist to speak authentically to the patient and his/her family (2, 3).

Indeed, Linehan is such a proponent of validation for treatment, she developed DBT (dialectical behaviour therapy) which is grounded in two core concepts - validation and problem solving.

External validation is not bad. Nor is it dysfunctional or overrated. It is simply a necessary component in the development of self-worth and independence. I am not indicating one should constantly and pathologically seek out validation, but it is a process many individuals need to go through and those who are need not view their behaviour as something to be rid of, but to be open to the validation they are receiving.

The above is true of anyone; we all need to know we’ve done a good job or look nice in that new shirt. Compliments, which are a form of external validation, improve productivity and mood, generally making the world a better place.

References:

1. Branden, N. (1969). The psychology of self-esteem. New York: Bantam.
2. Linehan, MM (1997). Validation and psychotherapy. In A Bohart & C. Greenberg (Eds.) Empathy reconsidered: New Directions. Washington DC: APA
3. Woodberry, KA, Miller, AL, Glinski, J, Indik, J, & Mitchell, AG (2002). Family therapy and dialectical behavior therapy with adolescents: Part II: A theoretical review, American Journal of Psychotherapy, 56, 585-602.

Saturday, October 24, 2009

Emotion Regulation Handout 8 – Extended

This is another adaptation of a worksheet taken from the Skills Training Manual for Treating Borderline Personality Disorder by Marsha Linehan. The skills in this book, as well as any other CBT or DBT book, are not limited to BPD nor are they limited to people suffering from any disorder, but are useful to all people.

The handout is a very lengthy list of possible pleasant events you can incorporate into your schedule to be used in conjunction with the ‘Build Positive Experiences’ exercise.
You can find the list here.

The length of the list can actually have a reverse effect in some cases; some basic activities are on the list and this may lead to ‘I’m already doing positive activities so I don’t need to do any more’ type thinking. The goal, of course, is to increase positive events, regardless of what one may be doing currently.

The first step is to go through the list and cross off any activities you know won't bring you any pleasure (for example, if you’re a vegetarian, hunting would be an activity you could remove). The list can also be used as an inventory for mastery skills; as you are editing the list, put an M next to any activity which you find particularly challenging.

Make sure you add in a few activities that are specific to you (e.g. buy new cactus for my collection). Add details to general activities (e.g. instead of ‘ride bike’ include ‘ride bike along beach,’ ‘ride bike to store’…; instead of ‘watch tv’ include ‘watch Show X, Episode 1’…)

Try using an office program (MSWord, Excel) to organise the activities into categories (e.g. exercise, art, social…). That way, if you are in the mood for a particular type of activity, you can locate it more easily. Also, manually rewriting the list will help the ideas stay in your head.

But there is always the problem of motivation and decision making during times of illness. So, try making the task a bit more random in order to alleviate this stress; print out your list and cut out each activity, and pull one (or two or three) out of an envelope each day. You may want a separate envelope for Mastery activities because in order for this method of randomness to work, you have to commit to whichever activity is chosen, no matter what, beforehand and since Mastery activities may be more challenging you may want to focus on those on days when you are feeling stronger.

At the very least, keep the list somewhere you can see it everyday to act as a reminder of possible activities.

Tuesday, October 20, 2009

Vitamin Water


Update here.


There was a commercial not too far back for which the advertisement said something along the lines of: why take your water and vitamins separately when you can take them both in one drink?


I was a bit offended that the marketing group would think people would find the task of taking a vitamin too arduous. More importantly, they were selling the product as something that’s good for you. However the colour of these drinks would indicate otherwise. Pretty, though.


The information below was obtained from various sources on the interweb and I suspect the values given are actually greater. I adjusted the per serving amounts to represent the actual amounts contained in a bottle (all conversions represent 591ml). Ingredients are in grams and vitamins are in percent daily values. Blank cells indicate no information was obtainable to myself.



Life Water

Dasani Plus

Aquafina Alive

Aquafina +

Glacéau

Coke


Calories

100

0

0

120

100

110

Fat

0

0

0


0

0

Sodium

87.5

62.5

162.5


0

30

Total Carbs

25

2.5

0


32.5

30

Sugar

25

0

0


30

0*

Fiber

0

2.5

0


0


Vitamin A





50


Vitamin C

100


100

250

200


Vitamin E

20

10

10

24

50


Vitamin B3

10

10

50

25

50


Vitamin B5




35



Vitamin B6

10

10

50

60

50


Vitamin B12

10

10


25

50



* Coke uses high fructose corn syrup as its sugar, as indicated by the carbohydrate content.


Ingredients in these beverages may also include fun things like artificial flavours, though some do use natural flavourings.


In summary, vitamin waters have varying vitamin content and may be high in sugar. The marketing scheme would have one believing the product is of a healthy nature. Yet, I believe any high sugar beverage (even juice) should be consumed in moderation so as to keep the kidneys functional. In fact, a cheaper alternative to some of these drinks would be to simply water down some juice.


The best way to get your vitamins is through food and supplements.


References: 1, 2, 3, 4, 5, 6