Tuesday, November 11, 2014


Around 7 years ago, I was diagnosed with ADHD.  I spent about six years taking (time release) Ritalin for it, but the Ritalin didn't help much.  One pernicious aspect is that doctors increase your dose slowly, so any side effects aren't easily tied back to the Ritalin.  This gradual ramp-up also makes it very difficult to figure out if the Ritalin is helping at all.  The side effects were terrible, but subtle:  I was much more grumpy, hyper vigilant, and jumpy.

In 1989, I flew from California to Boston to attend law school.  The flight landed, I got to the dorm, unpacked, and headed to Harvard Square to get lunch (I don't recall specifically, but I'm pretty sure it was a red-eye flight).  I was hungry, but for some reason I couldn't figure out where to eat.  I didn't know the area and didn't yet have favorite restaurants.  After about 30 minutes of walking, my muscles started hurting.  Given my subsequent CPT2 diagnosis, I now know that I was undergoing rhabdomyolysis, but at the time I just thought that my muscles were doing that weird thing again.  I walked past restaurant after restaurant, each time thinking that I just wasn't sure if I wanted to eat there.  I wandered into various stores and looked around.  I was very hungry at this point, and my muscles were screaming at me to sit down (at minimum) and eat.  But I continued to wander about for around two hours.  Luckily, I walked past a falafel restaurant (later to become one of my regular lunch spots) and after a few minutes of indecision, walked in.

What does my two hour restaurant indecision have to do with Ritalin?  Everything.  Think about how CPT2 deficiency works:  My body burns through its carbohydrate energy sources and instead of supplementing that with fatty acid metabolism, sticks with carb-only metabolism until it runs out of carbs and switches to burning muscle.  Implicit in this even is that my body is depleted of carbohydrates -- i.e. I've become hypoglycemic.  One of the common side effects of hypoglycemia is cognitive impairment.  In my case, massive indecisiveness.  "Should I eat here?  Or shop for a bit?  Or eat there?  Or sit down?  Well, I don't want to decide between those...."

As a CPT2 patient, I'm exposed to many times when my body is carb-depleted.  For me, that state is associated with difficulty concentrating and difficulty making decisions.  No wonder the Ritalin didn't provide much help -- ADHD wasn't the culprit (or at least, not the sole culprit).  The primary problem was my brain didn't have the energy to work right.

Fast forward a few months from my arrival at law school, and I remember being unable to study for more than an hour or so without grabbing a candy bar.  I was self-medicating for the CPT2-mediated attention deficit by pumping up my glucose levels.

I'm no longer taking ADHD medication.  Instead, I'm carefully making sure that I have a constant flow of carbohydrates (drinking Gatoraide G2 during the day, eating raw cornstarch for slow release carbs, etc).  I still have lots of challenges staying on topic (perhaps one of the big reasons I've been a successful inventor), but the episodes of complete loss of attention are much less common.  Moreover, when I do find myself having trouble concentrating, more often than when I do an inventory of my day's meals and activities, I realize I am in carb deficit.

I have no idea if I actually have ADHD or not, but (apart from the taste) cornstarch has far fewer side effects than Ritalin, and for this CPT2 patient, works just as well (or better).

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