What a Difference a Sandwich Makes

Living in a city like San Francisco is a nigh-constant assault of people in pain that want so much. Like most people, I learned to screen it out. I walk through the streets as if they were empty, clenched, haunted by a vague anxiety and fear.

While this is by no means healthy, this makes it less energetically expensive to leave the house. It still was hard, so for years, my goal was to get better at two things:

  1. Avoidance. Noise cancelling headphones and poor vision meant I actually don’t see or notice people around me. Just pretending doesn’t work, since subconscious movements and eye patterns will give you away. I also walk very quickly, so no one has much chance to engage with me.
  2. Boundaries. Getting better at refusals, saying “Sorry, no.” Having a policy not give money to people makes this easier. I break it sometimes when I feel like it or want to encourage things I like (like a cat on their head, great musical talent, raw charisma, or something that makes me feel genuinely good)

A few weeks ago, a friend of mine dropped off a box of delicious sandwich leftovers from their company office, more than I could eat. It seemed like a good idea to hand them out to people on the street, so I did. There were a couple immediate differences when I did this.

  1. Seeking. I was on the lookout for people who might want these sandwiches. When I came across someone and they asked me for spare change, I was pleased! I could offer them a delicious sandwich! It was a positive, not a negative, that they were requesting my attention. I was a lot less afraid. I was also surprised that it took so long to give out the sandwiches. When I’m avoiding, I feel as if there are people on every block. But when I was seeking them out, I realized that some people I thought were omnipresent were only there some days of the week.
  2. No, But. I had something of value I wanted to offer. Interactions were positive sum, relieving me of unwanted sandwiches and reducing waste, plus the people who got the sandwiches were quite happy about them. I was worried they’d be offended and prefer money, but this didn’t happen. I didn’t feel any guilt or awkwardness.

This made me wonder: If I had something concrete I could offer people that they would be happy to get over spare change, this would reduce a lot of my anxiety of living in a city. Ideally, this would be relatively cheap for me to provide and easy to carry everywhere. A pleasing social experience is probably the best thing, though I don’t know how to comfortably provide those on the fly.

Luckily, I got another box of sandwiches a few weeks later. Much of the same thing happened. I felt a lot less fear of engagement with the people around me. When my favorite camp had disappeared, I was surprised to find that I was disappointed.

This is the opposite of dissociation. Instead of assuming all of the sensations around me would be negative, I paid attention. I realized that actually, yes, I did like the feeling of being around some of these people and camps more than others.


I haven’t gotten any free boxes of sandwiches lately. But even now, when I recognize someone or spot my “favorite” tents, I tend to feel more interest and calm acknowledgement (or even curiosity) than avoidance and anxiety.

There’s still a ways to go. My next step is to have actual conversations with the people I’m curious about. I’ve only dared to with sandwiches in tow.

The Qualia of Lasik

I got Lasik eye surgery a month ago, early May 2019. Since then, my vision has been between 20/20 and 20/15. It is somewhat baffling to me that my vision never stops being good. Contacts get dry and the world clouds up as the day goes on. Glasses get dirty. My imagination was underprepared for the reality where my vision is excellent from when I wake up to when I go to bed, full stop.

Making the decision

Making the decision took several months. I knew for years that I wanted Lasik when I was old enough, and at age 23 I was taking the decision seriously. I had stable -1.50 vision in both eyes, bad enough that I couldn’t drive but not bad enough that I needed to wear contacts or glasses all the time.

The main questions were:

  • Would it be worth it if my vision isn’t that bad to begin with?
  • PRK or Lasik?
  • Are negative side effects likely? (Dry eyes, poorer night vision)
  • Is my age an issue?
  • Which surgeon should I go with?

The people who tend to say that Lasik is worth it start with terrible vision. Mine was only mediocre, so it was less clear up front.

“Going from -1.5 to 0 means you lose about an inch of sharpness at maximum closeness (2 inches from your eyeball) and you gain the entire world from 2 feet to infinity.”

Mars Van Voorden

The consensus I found from talking to friends who had gotten Lasik was that I had more to gain, especially with modern techniques and a good surgeon.

PRK vs Lasik: I considered PRK as an alternative to Lasik. The benefit of PRK is that it does not create a flap in the cornea, so the flap can’t be dislodged. In my first consultation, I found out that there is a lot more pain and risk of infection from PRK. Also, surgeons are less experienced at doing PRK. In hindsight, the pain of Lasik was enough for me. PRK sounds miserable.

If I did a lot of martial arts or contact sports or thought I would in the future, that may have tipped the balance. But even then, the corneal flap heals to around 90% of original strength within a few months (according to one consultation). One reason the flap is less of an issue is that a blade is no longer used to cut the corneal flap. A laser is used instead, which promotes healing better than the smooth knife cut.

Age: I’m in my early 20s. My optometrist was concerned about my age, since my prescription might still change in the future. Both consultations that seemed to think this was a non-issue. I knew for myself that my vision had been consistent for the past 10 years, so I judged that it was okay. If it does change within the next few years, I can get a corrective Lasik surgery. I hope I don’t have to. One thing that reassured me is that my mother and grandmother both got Lasik to great success.

Dry Eyes and Night vision: Most friends I knew with Lasik didn’t have problem, and the ones who did still felt it was worth it. I felt confident about the machines and skill of the surgeon I went with, and feel like this reduced my risk of side effects.

I was concerned about halos and worse night vision, but at the second consultation they explained that the new state of the art in Lasik could actually improve night vision.

One of my very trusted friends said this about night vision: “It got more like I was on acid all of the time. Lights are just brighter and more dominant than they used to be and finding things in true darkness is harder. I was also one of the last to get hand cut eye flaps, night vision is supposed to be improved in current generation all laser Lasik.”

Which surgeon: Two friends of mine had gotten Lasik from the same surgeon. A benefit was that it was cheaper than average in the area, which to me implied that the surgeon did more surgeries and thus had more practice. The machines they used in that office seemed to be the state of the art, the same ones used at the Lasik center at Stanford. The two friends also had no meaningful side effects.

Other considerations: With a low prescription like mine, there was a higher chance of having better than 20/20 vision.

I asked a lot of friends about this to see if I was missing anything big. Someone explained diopters, and how I would lose some ability to focus close up and need reading glasses sooner than otherwise. There were some stories of knowing someone where things went wrong, but many more personal anecdotes of Lasik being worth it.

Something I didn’t take into account was safety. I am much less likely to get hit by a car now, and feel a lot safer walking around city streets.

There are some downsides that might show up later on, but so far, Lasik seems very worth it.

Timeline of Subjective Experiences

The first four hours were incredibly uncomfortable. The eye numbing drops wore off around 20 minutes after the surgery. Opening my eyes was too bright. Even with my eyes closed, everything was too bright. This pain lasted for around 4 hours. During that time, all I could do was sit with my eyes closed while my body focused on healing.

The rest of day one, I was zoned out from Valium but was able to keep my eyes open enough to barely participate in my weekly Dungeons and Dragons game. After I could get my eye open, I could see things clearly, including screens and things up close. I did have to blow my nose every 15 minutes from the constant tearing.

On day two, it shouldn’t have been a surprise then that I got a cold. The valium, stress, and the constant tearing of my eyes at first led to a week-long feeling of clogged sinuses. I was pretty relaxed about it. Valium lasts a while.

Day three, I bought a pair of sunglasses. I found the darkest ones I could that would also block out UVA. Even then, the world was too damn bright. I was worried that I would be overwhelmed by people on the street and making eye contact with them, but this is entirely solved by wearing sunglasses. Also, I can see people from further off and avoid them more effectively. This isn’t an ideal strategy, but it’s how I cope with living in a city right now.

My eyes were no longer tearing. They were dry sometimes and uncomfortable, but not what I would call pain.

Later that day, I got bitten by a small dog. It was a small bite that didn’t break the skin but left a bruise. I broke down completely, barely able to speak and still hold back my tears. This was confusing! I knew that I didn’t care that much about minor pain. It wasn’t about the dog. I retreated somewhere private and sobbed for around 10 minutes before being able to interact with people again.

Something about that minor physical pain triggered a release of all of the numbed discomfort from the surgery. I had felt grief or loss about my old eyes since the surgery. My eyes had been trying very hard, and they weren’t good enough for me? That feeling of grief went away after crying.

This was also around when the Valium wore off. A thing I had to keep in mind was that Valium would interact with alcohol, making each drink dangerously more potent.

A week later, my eyes no longer felt like I had left contacts in them for several days. I thought “dry eyes” would feel dry, but really, it means itchy. I feel strong urges to rub my eyes every other day or so, and when I do, I put in eye drops.

One strange thing I noticed was that my hearing seemed to be better. The spatial cues in my environment or subtle lip-reading made some sounds feel louder. This could also be from freeing up processing power in my brain, now that interpreting my visual environment is so much easier than the interpolation and guessing from before.

Three weeks in, I’m still slightly sensitive to light but not in discomfort in the same way. Up until 2.5 weeks, I was wearing sunglasses outside every day, rain or shine. I no longer feel the need to when it’s overcast, but I think that sunglasses will be a larger part of my life now.

One nice thing about sunglasses I bought is that my vision is so clear that I can use the sides of my sunglasses as rear-view mirrors, and get a sense of what’s behind me without turning my head. This gives me a huge amount of extra spatial awareness I’m still learning to integrate, and when I don’t wear sunglasses I sometimes miss it!

I used to get headaches often. Getting Lasik reduced the amount of headaches I get. I now can pinpoint headaches down to more specific things, like reading in low light or looking at my phone in a car.

I also think this is helping my social skills significantly. I’m picking up and responding to a lot more cues from people. I have had less social anxiety since, and I hope it stays that way.

My depth perception and spatial awareness is a lot better, and this makes me feel less anxiety in general.

I feel freer in a way that is hard to pinpoint. If I were sent back in time, I wouldn’t have to worry about my vision. In the zombie apocalypse, I’d be able to spot them coming from afar. If I wanted to be a dirtbag traveling the world, I could do that all while seeing clearly. At festivals, I no longer will have to choose between seeing clearly and experiencing the pain of dust and sunblock that came from putting on contacts in a camping environment.

I’m a little disappointed that at no point did I get a feeling of euphoria from seeing clearly. No joyous “you’re free now,” or “this is so beautiful.” Instead, I get a few pings a day like “That’s convenient. You can see that person’s expression,” or “I guess it is kind of cool that you can see all of those nice rocks and trees right now.” I’m holding out some hope that my neurochemistry will change and that I’ll get a moment of euphoria when I look out at clear stars in a wide night sky.

Seeing Lake Tahoe bare-eyed

Many parts of the world are not beautiful. Still, I am not looking away. I feel safer, and brave in choosing to experience the world more fully.

In Favor of Writing

Many people I know do interesting research, have numerous projects, and routinely develop novel deep thoughts. Lately, every time they’ve told me about a thing they’ve been working on, I have encouraged them to write it up and put it where someone else could see it. Why?

A selfish reason is that I am writing more and would enjoy the company.

Another is that I believe that what my friends are doing is interesting and important. I want to be able to reference their work later and be able to share it with others.

Overall, I’ve found a number of benefits to writing up things. First are minor pleasantries, like a better vocabulary and the ability to write faster.

Another is in the pursuit of laziness. Rather than have to tell the same thing to ten people before growing tired of explaining, then to watch them forget it, I have an artifact that sticks around for much longer. I can share that artifact astonishingly efficiently. And in the future, when I forget the details of what I learned at the time, my old work can fill me in.

Which brings me to the most serious reason. Putting work where it can be seen means becoming in contact with reality greater than the inside one’s own ego.

When I write something up, I am flirting with reality. A blank page is perfect. But imperfect words on the page are real.

When I post it online, I am dancing with reality. Others can tell if my ideas are weak or if I’m onto something. My work is where people can see it and judge it on its merits. What I share can’t generate defenses and excuses on the fly like I can.

This provides accountability to ego claims. Posting something online is proof that I made it. I’m not wasting time appearing like the type of person that writes things, I’m writing things and putting them in places where people can check.

When reality dances back, that’s how you get feedback. If a tiny segment of the world likes what it sees, that’s a step in the right direction. You know that you’re creating value. If that tiny segment of the world doesn’t like what it sees, then it’s time to change audiences or admit that the work needs improving.

There are some other benefits. I’m often aware of how easy it is to consume what other people have created without even considering creating on my own.

By posting something online, I am becoming the type of person that creates value. I am building the habit and skills of production over consumption. Even if that artifact falls into the void unseen, the work done will make the next project easier.

When should something be written up?

The Schelling Time is now, and by the process of producing and allowing that work to enter a feedback loop, it will improve faster. Waiting for a complete concept, a fully baked idea, or the end of the project to before daring to create a shareable artifact almost always means that none will ever be created.

I recommend that if you have something you believe is worth sharing, start working towards sharing it on a larger scale. If it’s just in your mind, put it on the paper. Share it with one person. Post it and never publicize it. When you’re confident, cast it out further and adjust it as the feedback comes in.

Alcohol Harm Reduction

Drinking is fun sometimes. And, unfortunately, drinking is unhealthy. There are a lot of strategies to reduce hangovers, negative side effects, and damage to our health that are underutilized.

This is a relatively shallow dive aiming for simple interventions that make the biggest difference. This isn’t medical advice, I’m not a doctor. Please comment if I make a mistake, I’d like to know.

TL;DR: This stack from Life Extension is solid. Take it with alcoholic drinks to minimize liver damage and oxidative stress damage. Or, consider taking glutathione before or after a heavy night of drinking. And don’t forget to hydrate with electrolytes.

Metabolism Overview

Alcohol is broken down in the liver in two steps.

First, ethanol is broken down by alcohol dehydrogenase (ADH) into acetaldehyde. The first product, acetaldehyde, is more toxic than ethanol. It is a major cause of hangover. Buildups of it cause flushing, dizziness, nausea, and headaches. It might be responsible for the more unpleasant aspects of being drunk, such as the memory problems, sleepiness, and lack of coordination [2].

Next, acetaldehyde is broken down by aldehyde dehydrogenase (ALDH) into the harmless acetic acid (acetic acid is what makes vinegar vinegar). If there is a problem with ALDH via genetics, alcohol is substantially more toxic!

A fast ADH or a slow ALDH cause a buildup of acetaldehyde.

The overflow system, for when there is a lot of alcohol or an underperforming ALDH, is called the Microsomal Ethanol Oxidizing System (MEOS). MEOS does a lot of important metabolism already, and by having to process alcohol, it can’t do its normal functions, which can lead to a buildup of toxic byproducts.

Glutathione: Key Antioxidant

Glutathione is an important naturally occurring antioxididant, that is, it stops the harmful chemical stress caused by free radicals in the body. Glutathione is generated by the body and might be supplementable.

Glutathione is reduced when alcohol is consumed [3]. This is bad. Taking glutathione and other antioxidants reduces alcohol-induced liver damage [8].

There’s a lot of debate about how effective it is to take glutathione orally [4][5]. Due to how important glutathione is, it seems worth trying. A stack like this one by LifeExtension seems like it might work, and comes complete with a long list of citations.

Other supplements and foods

To indirectly increase glutathione levels, these might help:

  • Food containing sulfur. Uncooked meat, garlic, eggs, nuts.
  • Foods or supplements containing selenium. Brazil nuts, mushrooms, seafood.
  • Vitamin C [6]
  • Cysteine or N-acetyl cysteine (NAC)
  • Vitamin E
  • Milk Thistle Extract
  • SAMe [8]
  • B6
  • r-Alpha Lipoic Acid
  • Curcumin

Mixing with other drugs

The short story is that breathing is good. Depressants that also lower heart rate and breath rate are dangerous, and there are a lot of drugs that do this.

For a short list, avoid alcohol and these things:

  • Benzodiazapines. Benzos stay in the system for 24+ hours, so if you took one yesterday it still might not be safe to drink today. They synergize aggressively, causing dangerously low breath rate and heart rate. (Also blackouts and intense stupidity, just read /r/drugs for an hour)
  • Opiates. Breathing is good for you and your brain
  • Sleeping medicine like Ambien
  • Be careful with alcohol and muscle relaxants. This can exacerbate the physical effects of alcohol leading to a potentially dangerous lack of coordination and balance
  • Altitude. It’s not a drug, but it’s hard to get enough oxygen at altitude. Drinking when you’re already feeling altitude sickness will not only hit harder, but increase risk of hypoxia.

Certain antidepressants, like Buproprion / Wellbutrin, don’t mix well with alcohol. When on an MAOI antidepressant, especially avoid red wine. Red wine plus an MAOI causes a new and fun sort of toxicity known as “cheese headaches”, which are uncomfortable and cause high blood pressure.

This isn’t a complete list of what to be careful of. Talk to your doctor, and if you don’t do that, check the Drugs.com Interactions Checker for prescription drugs or Tripsit.me Interaction Chart for illicit drugs.

Phenibut

Phenibut (β-Phenyl-γ-aminobutyric acid) is an anti-anxiety drug used in Russia. It’s unregulated and relatively unknown in the US, and can be purchased online. It’s a GABA-B agonist, meaning that it will relax muscles, increase feelings of relaxations, and decrease anxiety.

Despite grey area legality, I found it listed as an ingredient in 7-11

Many people take alcohol in order to reduce social anxiety. Phenibut reduces anxiety without many of the negative effects of alcohol. If social anxiety is the primary reason for drinking, Phenibut is a great replacement (sometimes).

Phenibut and alcohol synergize aggressively. This means that you can easily harm yourself by drinking like normal while on phenibut. But this also means that you can take phenibut and drink much less alcohol than normally, while still getting as strong a buzz.

Keep in mind: Like alcohol, phenibut is addictive, but causes fewer health issue than alcohol does. The withdrawal is known to be terrible if you do get addicted, so be careful. A good rule of thumb is to take it once or twice a week, and no more. The larger the dose is, the

Demographics and Genetics

Many people have mutations in the genes for either ADH or ALDH. Sometimes this is apparent from symptoms, and if not, an analysis of 23andme data could find something.

Mutations in the genes for ADH mean the risk of cancer from drinking is much higher [7].

Mutations in the genes for ALDH are very common and make alcohol substantially less healthy.

From Wikipedia, emphasis my own:

About 50% of people of Northeast Asian descent have a dominant mutation in their acetaldehyde dehydrogenase gene,[6] making this enzyme less effective. A similar mutation is found in about 5–10% of blond-haired blue-eyed people of Northern European descent.[7] In these people, acetaldehyde accumulates after drinking alcohol, leading to symptoms of acetaldehyde poisoning, including the characteristic flushing of the skin and increased heart and respiration rates.[7] Other symptoms can include severe abdominal and urinary tract cramping, hot and cold flashes, profuse sweating, and profound malaise.[7] Individuals with deficient acetaldehyde dehydrogenase activity are far less likely to become alcoholics, but seem to be at a greater risk of liver damage, alcohol-induced asthma, and contracting cancers of the oro-pharynx and esophagus due to acetaldehyde overexposure.[7]

If you experience those symptoms and have that genetic marker, be aware! You’re more likely to get diseases from drinking alcohol. This is balanced by the cursed gift that the ALDH mutation makes drinking less pleasant, so at least those with it are less likely to become heavy drinkers.

Females have less active ADH and lower H2O levels relative to body mass. This means the MEOS system is more often used in alcohol metabolism, which is less ideal in general.

The older you are, the more toxic alcohol is. One reason is that glutathione synthesis gets worse with age [3].

Harm Reduction for Severe Alcoholism

Well. Given that someone is an alcoholic, there are multiple interventions that can reduce cancer risk and liver damage and increase overall health.

Alcohol consumption interferes with ability to absorb nutrients, plus alcoholic drinks tend to have very few nutrients! This means that alcoholics are likely to be seriously malnourished in both macro and micro nutrients. [1]

First, start taking Vitamin C, B Vitamins, and either Vitamin A or beta-carotene. If you aren’t a heavy drinker, skip the Vitamin A, as large doses above what is normal can be toxic.

Then, start aggressively supplementing whey protein. Next, get a blood test to see what you’re most deficient in, and start working to reduce those deficiencies.

If you’re malnourished or on a low protein diet, ADH works less efficiently, meaning that blood alcohol levels stay higher for longer. Like those with genetic mutations on ADH, this will cause more disease in the long run.

Summary and Stack Suggestions

Convention wisdom for alcohol safety, like how to pace your drinking and keep hydrated, are no less important. Overall, the more unpleasant the hangover or alcohol experience is, the more likely it is to be toxic. Reducing hangover symptoms is caring about your health.

My stack, optimized for convenience and health, is:

  1. Life Extension Anti-Alcohol Complex. This has Vitamin C, E, Selenium, NAC, Glutathione, and a whole slew of other ingredients that have some evidence behind them. This is a one-stop pill. Take one pill with each drink, up to 5 pills. If you’re taking this, be careful taking other supplements that might contain some of the same ingredients.
  2. Replenish that glutathione and drink water with a PowerPak of Electrolytes (which contains Vitamin C, B Vitamins, and Selenium) the next morning.

Further questions

  • Phenolic compounds on ADH and ALDH
  • Alcohol and acetaminophen: Additive or negatively synergistic?
  • There are two forms of glutathione one can take: L-glutathione (also called reduced glutathione) vs s-acetyl l-glutathione. Which one is better?
  • The MEOS system: how it works and what it depletes, and what the tradeoffs are
  • Healthy balance between NADH and NAD+ levels. Impacted by alcohol?

Resources

  1. Relationships Between Nutrition, Alcohol Use, and Liver Disease. [link]
  2. Alcohol Metabolism: An Update. July 2007 from the National Institute of Health sub-department National Institute on Alcohol Abuse and Alcoholism [link]
  3. Glutathione Depletion and Recovery After Acute Ethanol Administration in the Aging Mouse. Vogt 2008. Biochem Pharmacol. [link]
  4. Bioavailability Study of an Innovative Orobuccal Formulation of Glutathione. Buonocore 2015. Oxiditative Medicine and Cellular Longevity. [link]
  5. Enhanced Glutathione Levels in Blood and Buccal Cells by Oral Glutathione Supplementation. Richie 2013. FASEB Journal. [link]
  6. Vitamin C augments lymphocyte glutathione in subjects with ascorbate deficiency. KJ 2003. Am J Clin Nutr. [link]
  7. Alcohol dehydrogenase 1C*1 allele is a genetic marker for alcohol‐associated cancer in heavy drinkers. Homann 2005. International Journal of Cancer. [link]
  8. Overview: How Is Alcohol Metabolized by the Body? Zakhari. [link]