Dr. Alison DeMiero Functional Health Educator

04/16/2026

Before you quit to start a private practice, ask yourself 3 questions:

1️⃣ What problem am I actually trying to solve?
Burnout? Cash flow? Autonomy? All of the above? If you don’t name the real problem, you can accidentally rebuild the same stress with a nicer office.

2️⃣ How many patient hours can my brain and body truly handle each week?
Not what a productivity metric says. The actual number you can sustain without needing a second nervous system.

3️⃣ What does “enough” income look like for me in this season of life?
If you don’t define “enough,” you’ll assume the only solution is “more patients,” even when the math and your energy say otherwise.

Private practice can be amazing.
But the model you choose matters more than the setting.

If you’re an employed or private-practice clinician thinking about these questions, I’m building a small community and sharing how to redesign your work so you’re not relying on “more patients” as the only plan. Comment “SKOOL” or send me a DM and I’ll share the details.

04/16/2026

For Clinicians Who Are Tired, Underpaid, and Wondering If Private Practice Is the Answer

04/14/2026

What gets absorbed, not billed — and why that’s the real problem

04/12/2026

Why more patients — or private practice — might not be the answer you’re looking for

03/23/2026

03/07/2026

ADHD is one of the most misunderstood conditions I see in my practice.

Many of my patients spent years thinking they were just lazy, undisciplined, or not trying hard enough — before they finally got answers.

But here's what I wish more people knew: ADHD isn't just about attention. It involves the brain's dopamine and norepinephrine pathways, and it often shows up alongside gut issues, nutrient depletions, blood sugar instability, and chronic inflammation.

Medication can be an important tool — and I prescribe it when appropriate. But when we also investigate what's happening underneath the symptoms? That's when people often start to feel like themselves again.

If you know someone who's been struggling with focus, motivation, or attention — please share this. It might be the thing they needed to see today.

This is educational content and not medical advice. Always consult your healthcare provider.

Seattle Therapeutic Services | Virtual Psychiatric Care in Washington State

(206) 672-2122 | seattletherapeuticservices.com

02/23/2026

You wake up at 3 AM. Every. Single. Night. Wide awake. Mind racing. Can’t fall back asleep no matter what you try.

You’ve tried melatonin. Sleep hygiene. Putting the phone away. Magnesium gummies. Nothing works. Your doctor offers trazodone or Ambien and says “let’s see if that helps.”

But nobody is asking WHY you’re waking up at 3 AM in the first place.

That 3 AM wake-up often has a very specific pattern behind it — a cortisol spike. Cortisol is your body’s main stress hormone. It’s supposed to be at its lowest in the middle of the night and rise gradually to wake you in the morning.

But when your stress response system is dysregulated, research suggests cortisol can surge hours too early. It may suppress melatonin, activate your nervous system, and snap you wide awake.

No amount of sleep hygiene addresses a hormone that may be firing at the wrong time.

So what may be contributing to the cortisol misfiring?

Chronic stress that has worn down your HPA axis over months or years. Blood sugar dropping too low overnight — research shows that insufficient protein or fat at your last meal may contribute to overnight blood sugar instability, which can trigger a cortisol response.

Gut inflammation that may activate an immune response affecting your stress hormones. Hormonal shifts — especially in perimenopause, when progesterone drops and cortisol may lose its counterbalance.

This is why a sleep medication might help temporarily but often doesn’t resolve the underlying pattern. You may be treating the wake-up without addressing what’s contributing to it.

In my practice, when a patient tells me about the 3 AM wake-up, I start with questions. What does your evening meal look like?

How long have you been under chronic stress? Where are you in your hormonal cycle? And I assess cortisol patterns, fasting insulin, inflammatory markers, and hormones — to look for what may be driving the problem.

When we investigate and address what may be underneath, many patients find their sleep begins to improve on its own.

If this sounds familiar, talk to your provider about looking beyond sleep hygiene.

And if you’re looking for a provider who takes this approach, I see patients virtually across Washington state.

Regence, Premera, Kaiser, Aetna, Lifewise, UMP, RGA accepted.

This content is for educational purposes only and is not medical advice. Always consult with your healthcare provider before making changes to your treatment plan.

02/21/2026

Your ADHD medication worked great at first. Maybe for weeks, maybe for months. But now it's not working like it used to. You need a higher dose. The side effects are getting worse. And your doctor's only answer is to try a different medication.

But here's what almost nobody checks before prescribing — or before increasing your dose:

Your zinc levels. Research shows that zinc plays a critical role in dopamine production. Without adequate zinc, your brain may not be able to produce dopamine as efficiently — which can affect how well stimulant medications work. The medication may not be failing you. Your brain may be missing what it needs to respond to the medication properly.

The same is true for iron — specifically ferritin, which is your stored iron. A ferritin of 15 is technically "in range" at most labs. But studies show that ADHD symptoms are often more pronounced when ferritin falls below 30-50. Restlessness, poor focus, brain fog, irritability — all associated with low ferritin in the research.

Then there's magnesium, B6, and omega-3 fatty acids. These aren't trendy supplements. They're essential building blocks that research shows play a role in how your brain regulates attention, mood, and energy.

I'm not anti-medication. I prescribe stimulants regularly in my practice. But I also assess nutrient levels — because when we address what may be missing at the foundation, many patients find their medication works more effectively, sometimes at lower doses with fewer side effects.

If your medication isn't working the way it used to, ask your provider about checking your nutrient levels. It could make a meaningful difference.

I see patients virtually across Washington state and accept Regence, Premera, Kaiser, Aetna, Lifewise, UMP, and RGA.

This content is for educational purposes only and is not medical advice. Always consult with your healthcare provider before making changes to your treatment plan.

02/15/2026

Your ADHD medication worked great at first. Maybe for weeks, maybe for months. But now it's fading. You need a higher dose.

The side effects are getting worse. And your doctor's only answer is to try a different medication.

But here's what almost nobody checks before prescribing — or before increasing your dose:

Your zinc levels. Zinc is a critical cofactor for dopamine production.

Without enough zinc, your brain physically cannot produce the dopamine that your stimulant medication is designed to regulate.

The medication isn't failing you. Your brain is missing what it needs to make the medication work.

The same is true for iron. Not just your basic iron level — your ferritin, which is your stored iron. A ferritin of 15 is technically "in range" at most labs.

But research shows that ADHD symptoms worsen significantly when ferritin is below 30-50. Restlessness, poor focus, brain fog, irritability — all connected.

Then there's magnesium, B6, omega-3 fatty acids. These aren't trendy supplements. They're essential building blocks your brain needs to regulate attention, mood, and energy.

I'm not anti-medication. I prescribe stimulants regularly in my practice. But I always check nutrient levels first — because when we address what's missing at the foundation, the medication works better, often at lower doses, with fewer side effects.

If your medication stopped working, don't just increase the dose. Ask your provider to check your nutrients. It could change everything.

I see patients virtually across Washington state and I accept Regence, Premera, Kaiser, Aetna, Lifewise, UMP, and RGA.

02/15/2026

Have you gotten the influenza this year? If so, how did you fare?

01/12/2026

Let's talk about anxiety in perimenopause.

Many women report increased anxiety, worry, or a general sense of unease that wasn't there before.

Research shows this has a biological basis:

Studies suggest that progesterone affects GABA (your brain's calming neurotransmitter). When progesterone declines in perimenopause, GABA signaling may be reduced.

Lower GABA activity could contribute to:
- Increased anxiety
- Racing thoughts
- Difficulty relaxing
- Worry that feels "out of proportion"

This isn't "all in your head." It's neurochemistry.

Understanding the mechanism can help you explore evidence-based approaches with your healthcare provider.

Have you experienced increased anxiety in perimenopause? 👇

⚠️ Educational content only. Not medical advice. Always consult your healthcare provider.

01/09/2026

🌸 Exciting News! I just launched a FREE educational community for women navigating perimenopause.

If you're experiencing:
- Brain fog that's affecting your daily life
- Sleep issues (especially 3 AM wake-ups)
- Unexplained weight gain
- Chronic fatigue
- Mood swings or anxiety

You need to understand what's actually happening in your body.

The 10 Metabolic Shifts

Research shows there are 10 specific metabolic changes that occur after 40 during perimenopause. These shifts affect your:
🧠 Brain function (memory, focus, clarity)
😴 Sleep quality and architecture
⚡ Energy levels
⚖️ Metabolism and weight
😊 Mood and emotional regulation

When you understand these root causes, you can have much more informed conversations with your healthcare provider about approaches that might help.

Join my new educational community:
👉 skool.com/perimenopause

Inside you'll find:
✅ Research-based educational content
✅ The science behind each metabolic shift
✅ Evidence-based information
✅ A supportive community of women going through the same thing
✅ No ads, no spam—just education

Led by Dr. Alison DeMiero (DNP, PMHNP-BC, Functional Medicine Fellowship)

⚠️ Important Disclaimer:
This community provides educational content only. This is not medical advice. I am not acting as your healthcare provider. Always consult your qualified healthcare provider before making any health-related decisions.

Join us! 💙

Research-based solutions for brain fog, insomnia, weight gain & fatigue. Led by Dr. Alison DeMiero (DNP, PMHNP-BC, Functional Medicine).