Rethinking How You Think About Eating


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How many times a day do you hear “I should…” statements run through your head? Everyone always wants to tell us what we “should” and “shouldn’t” be doing in literally every area of our life. 

Our moms, our relatives, our friends, our co-workers, complete strangers, our health-care providers, the media… 

What we should do with our life, what we should weigh, what we should eat, how we should raise our kids, how we should look, who we should be, what we should know, how we should take care of ourselves, what skills we should have, how we should age, how we should dress, how we should do our hair or our make-up, what things we should care about in life, how we should have sex or “please our men”, how we should decorate our house, what we should read, what we should think, how we should act… 

We get programmed by outside influences to believe all these things we “should” be doing and then we obsessively remunerate over them — usually while flogging ourselves because we haven’t or don’t.

There’s literally a “women should” piece of advice for EVERY single aspect of our lives, they usually differ depending on who you talk to and we often we tend to carry way too many of them with us every day, as though constantly reminding ourselves is going to make us do them. 

Then, we judge ourselves accordingly based on how we think we’re measuring up – or not. Usually not.

And we wonder why we walk around with guilt, shame, anxiety, depression & obsessed with food every day? 

Should statements” are all of those things you’re telling yourself you “should” be doing every day — but don’t. 

They’re one of many cognitive distortions (or negative thinking patterns) that contribute to stress, fear, worry, guilt and shame. 

“I should be eating better and losing weight and I can’t ever stop reminding myself of that every single day until I die — because then I’ll never do it.” “Ugh, the house is such a mess, I should be cleaning it. What’s wrong with me? Why I can’t I just make myself get up and clean the stupid bathroom?”

“I’ve been so busy lately, I haven’t spent enough time with the kids. I should be doing more with them. I’m the worst mother.”

The next time you hear an “I should” thought run through your head or statement come out of your mouth, stop. 

Notice what happens next. How do you feel about yourself in those moments? Empowered, happy and good? Or hopeless, helpless and bad? 

And do you immediately follow that statement and those feelings by doing that thing you’re telling yourself you “should” be doing? Or not? See, the reason they’re problematic is they almost never result in more positive choices or the outcomes we want. 

Rather, they make us feel badly about ourselves and often more hopeless about actually being able to do that thing we’re telling ourselves we “should” be doing.

“I should be eating that…” usually results in NOT eating that thing because we start thinking, “why can’t I have more self-control with food? I know what I’m supposed to be eating, why can’t I have some willpower and do that?”which reinforces feelings of being helpless to our circumstances and our choices not being within our control.

“I should be exercising more…” usually results in NOT exercising more because we follow it with, “but I’m just so lazy. If only I had more motivation.” which again, reinforces feelings of the choice being out of our control and makes us feel hopeless about changing it. We “should” be… but we’re just too lazy, we believe. So we carry around this belief that we’re unworthy or that we’re destroying our health because we’re too lazy to do the exercise everyone tells we “should” be to be healthy, or hot or skinnier or stronger or whatever.

And should statements aren’t limited to just what we eat and our exercise habits. We use them for everything – our parenting: “I should have more patience with my kids”,our homes: “I should be a better housekeeper”, our relationships: “I should be a better wife, mother, daughter, sibling, friend”… etc. Should statements are just one of many cognitive distortions that contribute to depression, anxiety, panic and can even keep us stuck in the weight & food battle. 

And cognitive distortions often don’t act alone. Should statements, all or nothing thinking, and labeling/mislabeling can, and usually do pile on top of each other in one nasty thought bubble whenever we “fall off the wagon”. 

“I should be eating salad but I really want pizza. Screw it, I may as well just have the pizza. I always just end up screwing up eventually anyway.” which then leads to “I may as well have a beer with it, and some chips and ice cream for dessert since I already ruined today. I’ll just start over tomorrow.” which then leads to “God, I’m such a pathetic screw up. I always do this. What’s wrong with me?”

That’s a should statement, all or nothing thinking, and labeling/mislabeling – a common threesome of cognitive distortions that often results in overeating (or in some cases a full-on binge) in people who struggle with weight & food all because they just wanted a piece of pizza.

Cognitive restructuring is a helpful cognitive-behavioral technique that I’ve incorporated in The Cognitive Eating Academy. It’s designed to help you overcome should statements and other cognitive distortions that keep you stuck in these faulty and self-destructive ways of thinking – and as a result, behaving.

The day I gave up should’ing myself to death was one of the best days ever. Now, when I hear myself thinking or saying, “I should…” before something, I next ask myself, “says who? Who says I should be doing that? What do I WANT? What does MY body need? What’s best for me? What do I need most right now?”

Rather than making ourselves miserable by trying to live up to what everyone else determines we “should” be doing, this switch gives us our power back. It gives us the power to start learning what makes us happy, what’s best for our own mental, emotional and physical health – and how to follow our own hearts, minds, bodies and dreams. And if you need it, I created The Cognitive Eating to help.

Roni Davis

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Immigration and Pharmacy – Success Stories

Pharmacy practice is filled with amazing individuals.  We all know Pharmacists that stand out for various reasons. Lately there has been a climate of intolerance towards those that come to Canada or the U.S. from another country. This confuses me given the history of successful immigration not only in Canada but other countries as well. Pharmacy practice is no stranger to this and I have found it necessary to share the brief stories of just a few of the many immigrants to Canada that have and continue to contribute to the profession of Pharmacy.  My regrets are that I couldn’t include more people here and that their stories are so abbreviated in the interest of space.  These are the stories of just 3 such individuals to spotlight their paths of immigration and contribution to Pharmacy and to Canada.

KYRO

My first call was with Kyro Maseh, a Pharmacist from the Toronto area.  He came to Canada in August 1996 with his family from Egypt.  The main reason for their move was the growing religious discrimination they were seeing and decided it was time to leave.  He was 8 years old when they arrived.  His mom was a Pharmacist, which helped their acceptance into Canada.  At the time Canada was looking for Pharmacists from Egypt and his parents read that it was a good place to raise a family. His dad was a well-known and respected vetrinarian of livestock in their area but gave up that profession when they came here.  Kyro had very little English language and no alphabet skills when he came here but you would never know that now.  He now speaks French, English and Arabic.  His early days in Canada were modest by his standards today and back in Egypt.  Their furniture came from what they could scrounge up from the garbage and housing was not luxurious to say the least.  To add to the family’s stress, his mother was diagnosed with cancer after their arrival.

Kyro eventually returned to Cairo for his Pharmacy education.  At a metropolitan centre he wouldn’t experience the same discrimination as his family did in Asyute where he was born.  One day a mother came into the pharmacy and told Kyro that her son didn’t wake up that morning, he had overdosed.  She said to him that she wished someone had warned him. It was in The Beaches area of Toronto where there is a small community feel.  He began to feel at this moment that it was his calling to help educate others, particularly young people about addiction and prevention of addiction.  Mental health and addiction became an area of focus for Kyro from then on.  He feels that as pharmacists we are good at talking to people and we are knowledgeable in science.  Teaching then becomes an important and natural part of our job. His #EndTheCrisis campaign tries to focus on kids on awareness of addiction.  His warning in hesitancy of immigration points to the case of Raymond Schinazi, who was forced from Egypt, only to become instrumental in the development of antiviral medications we use in pharmacy today.  He says there is strength in diversity, something he is living proof of.

Christina

Tina Privado Azzopardi (Christina) grew up in a relatively poor setting with both of her parents, 3 brothers and 1 sister on the beautiful island of Cuyo in the Philippines.  It’s an area that is quite isolated transportation-wise from the urban areas of the Philippines and very much more laid back.  To see this tiny spit of land on a map verifies the isolation they lived in. She moved to the more metropolitan centre of Manila to pursue a degree in Pharmacy and graduated in 1997.   This would not have been possible without the scholarships she received and monetary help from an Aunt she moved in with during that time in Manila.  Her Aunt was a business owner and fairly well to do.  In return, Christina would help out with the bookstore business as was needed. Upon graduation, she was employed as a lab instructor at the private University she had attended and worked there for 5 years.  The pay was not high in this position.  

Pharmacy practice and overall healthcare in the Philippines is quite different than here in Canada.  She recalls the system as very sad and medications can be difficult to obtain with little structure to any healthcare system, little private insurance, and expensive prescriptions.  The Physician is rarely challenged on a prescription when it comes to switching to a generic or dealing with an interaction.  Physicians are held in high regard like they are here, but it is more of an authoritative role.  Collaborative care with a Pharmacist’s input is not common.  Brand name reps often visit the physicians and leave samples. This leads the physician to often write for the brand name of medications and there is no switching to generics unless it is written for.  Christina tells me it is still this way today back home.  It is not uncommon for antibiotic prescriptions to be filled for part of the total days supply due to the cost.  Being on a chronic medication can financially ruin a family that tries to pay for them.  

Christina eventually saw a benefit in working in Canada.  With the help of a broker that spearheaded the move for Zellers who was looking for pharmacists, she prepared herself for the transition, which included 3 qualifying exams.  She recalls this as an unsure time as scams were often present with such brokers.  At the time, the internet wasn’t as widely used as today and verification of such scams was more difficult.  Eventually, through friends of hers that knew the friends of the broker she was fairly satisfied this was above board and made the move with a group of 5 others; all academia and non-retail in background.  This particular group came from Centor Escolar University and from the University of the Philippines.  Unfortunately for Christina and her family her father passed away of cancer before her time to leave came.

She recalls her arrival in the GTA after 24 hours of travel when the 3 girls in the group opened the door to their new apartment and realized it was completely devoid of furniture.  It was a feeling of emptiness she recalls.  She recounted having the bed sheets she travelled with that night and they eventually got some furniture that was donated by other Philippino families living in the building.  It was in a building that had many other immigrants from the Philippines.  She lived in Barrie for three years where she worked and paid off her commitment to Zellers.  Making the switch from academia to retail in a corporate environment was tough but she was mentored during that time and felt comfortable becoming a store-owner after that.  She embraced the chance to become involved in the independent Pharmacy world.  She now owns a store on her own and partly owns three others.  She purchased a home, got married and has a 6 year old son in Tottenham, Ontario, about 70 km from Toronto.  Her mom stays with her for ¾ of the year and goes back to the Philippines for the remainder. Her commitment to the pharmacy profession is obvious but her 6-day weeks with 4 stores will hopefully become 4 day weeks to give her more family time eventually.

Johnny

Johnny Marya has no direct recollection of his birth country of Greece.  His parents were Christians living in Syria, a minority group in that country.  His father started work when he was 13 with Johnny’s grandfather in the jewelry business in Syria.  It was a family of 6 children and a life of productive work looked more favorable than school.  Early on they knew that North America offered more potential than they saw in Syria, including education for Johnny.  Before Johnny was born they moved to Greece where they lived for a short time around his birth.  His Father became a jeweler – making a fairly good living there.  They decided to begin the work to start the path to Canada and his father moved his wife and Johnny back to Syria while he went to the U.S. to begin the paperwork to have the family moved over here.  The year was 1989.   This is a process that lasted nearly three years.  During this time he didn’t see his father, who supported the family from the U.S., undoubtedly a long period for Johnny.  Finally, in 1992, when he was 2 ½ he moved to Montreal with his mom to be reunited with his dad.

Growing up in Canada offered Johnny and his family (which also now includes a sister) opportunities and education they would not have had back in Syria.  Johnny saw the value of education.  As an immigrant it was instilled in him to get an education first in order to be successful and to work hard to get what you need.  He went to work at small jobs at the same age his father did as a young boy.  His first job was at a grocery store, receiving orders and preparing fruits and vegetables for sale.  His next jobs included a Subway, a Theatre, a paper route, a duty free shop at the airport, snow removal, a forklift driver at a warehouse, a truck driver for a delivery company, and a clothing salesman for H&M. With his family they also started a tourist agency and a popcorn company, both of which they ended up selling.

As Johnny started his 4 year Bachelor’s degree in finance, he approached his father to rekindle the jewelry business that he had started to wind down.  Johnny developed a business plan and incorporated a proposal that included updated technology and smaller batch custom-made jewelry production with little to no overhead in inventory.  This was a busy time for him, working 40 hours per week while in university.  During this time he interned for a live broadcasting company that expanded and offered him a great job that he couldn’t refuse so he took that job and still offered to help his dad with the jewelry business.  He was 22 years old at this point.  He worked there for a year and turned to a recruiting agency to find a job in finance.  He was immediately offered a job with the recruiting company and within 2 years he was one of the top producers, mainly with pharmaceutical companies.  This is how he started to learn about drug companies, including McKesson.  His sister also became a Pharmacist.  After some extra legwork he convinced his future employers at McKesson that the recipe to a successful hire of a salesman isn’t in the salesman’s background in what they sold in the past (like automation), it’s in the ability of the individual to sell.  After all, Johnny spent a long time with the recruiting company coaching others in how to nail an interview.  Johnny has become Regional Sales Manager for Atlantic Canada and been doing that job for 3 years.  

Johnny’s extended family has also immigrated.  An uncle who was a physiotherapist back home, now works in Canada as a masseuse, another uncle is a successful physician in New York, and a cousin is with the Canadian Army.   Johnny’s story underscores the belief that immigrants often have a strong work ethic, come to Canada because they recognize the simple formula of education and hard work leading to success, and can be hired by companies that recognize this value and potential in this country.  While he not a Pharmacist, Johnny represents one of the many immigrants that have come to this country and contribute immensely to healthcare through their special expertise, not to mention the contribution of his family that also came to North America.  He has contributed to the success of many Pharmacies in this country.

The stories from immigrants were all equally interesting for differing reasons as I interviewed them for this blog.  I soon realized it was going to be difficult to tell their stories fully to and keep the blog’s length appropriate.  Immigration has proven to contribute to the success of Pharmacy in Canada.  Its benefits are seen both directly through immigrants who began here with a Pharmacy career and flourished, but also through the children of descendants that have come here from abroad.  Something I have learned through this exercise is how Pharmacy operates in other parts of the world.  From the examples I have heard, Canada is actually an excellent country to practice this profession, given the complaints we may have here in this country.  The respect given to Pharmacists and the value of pharmacy as a profession is strikingly higher here comparatively.  Thanks to all for their contributions in helping to promote the value of immigration through our profession.

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The Mental Health Effects of Weight Stigma & Why We Have To Stop Pushing Diet and Exercise As a “Solution”

I have been working lately with Roni Davis in helping patients understand the concept of “Healthy Weight” and how weight loss. Roni has been through the cycle of regular person, regular person who became concerned with weight gain, regular person who went through diet weight loss and weight gain, regular person who struggled with their mental stability due to dieting, figure athlete, personal trainer, and then to a regular person who talks people down from how they feel about their weight to how they should feel about their weight. Roni’s experience reflects not only what people feel after years of struggling with maintaining or losing weight, but also shows the results of a growing food environment that sets up the general population for failure from the time they wake up until they go to bed – even if they don’t leave the house. We also need to be aware of comments that are derived from privileged individuals who supply advice based on personal feelings of overweight individuals. While I’m a big fan of “not one eating pattern can claim to be the single plan for everyone”, her words of comfort are based on one woman’s experience from a high altitude level that helps to ground everyone.

Last week apparently Bill Maher went on a rant about fat shaming. His argument? We need more of it.

James Corden replied with this:

“If making fun of fat ppl made them lose weight, there would be no fat kids in schools, and I’d have a six pack by now.”

“I’ve been off & on diets since as long as I can remember & this is how it’s going.”

James Corden

It was brilliant. But even he’s still missing the point a little and so I wanted to really dive into the topic. 

That is, fat shaming, weight stigma, and weight loss because like Bill Maher I was someone who also used to fear the fat acceptance movement – but as they say, when we know better, we do better. 

So, what will follow is decades of personal experience, as well as, almost a decade of professional experience.

You see, like tens of millions of other people, I also bought the lie. You know the one I mean, the one that says if I was only thinner, if only I was smaller, if only the scale displayed a lower number, if only I could stick to “diet and exercise” then I’d be worth something – then I’d be happy and healthy and life would be perfect. The lie that says only people who are lazy and no self-control gain weight – the lie that says if only I’d get off my ass and diet and exercise – then I’d be skinny and worthy of love, belonging, goodness, and respect.

THEN, I’d be happy – I’d be worth something. 

But it almost killed me.

And it’s all lies. Right down to the “diet and exercise solution” we’ve been sold – and I say that as a former award-winning personal trainer/nutrition & wellness coach.

Have you noticed this?

You’re sitting around chatting with friends, the subject of weight, or your bodies comes up and everyone is expected to add something derogatory about their body.

“I’m so fat. I’m so gross. This shirt makes me look like a whale.”

“Yeah, me too… I can’t take it anymore and am starting that keto thing on Monday – so gotta enjoy myself this weekend cuz I’m not gonna be allowed to eat this anymore after that” 

And if in that discussion you piped up and said, ‘I actually feel OK about the way I look,’everyone there is going to judge you, scrunch up their noses and think “well doesn’t she just think she’s special”…and they probably wouldn’t call you to hang out anymore. 

That’s how pervasive and expected body hate has become.

We’re supposedto be ashamed of our bodies. 

It’s become not only more acceptable to insult your body than it is to praise it, it’s expected.. it’s even become how we bond… in this weight stigma fueled, collective dysfunction of disordered eating that is serial dieting and body hate.

And it is so toxic. 

My mother has always told me about this one time I was with my grandmother in K-mart when I was 2 – sitting in the shopping cart, I pointed across the aisle and asked loudly… Grammy, why is that lady so fat?!

I was 2. I wasn’t born knowing what fat meant but by the time I was 2 years old, I had already been taught to judge it, to question it and not want to be it.

I was taught that “letting myself go” by gaining weight was a fate worse than death.

So, in my mid-teens, when I put 2 or 3lbs, I was horrified and desperate to take it off.

That first attempt at weight loss, would have ended in a very different way had I known then what I know now. 

But those were the Atkins days.

His low-carb miracle cure said carbs were the problem and my weight loss dreams would be answered if I just quit those. But the more I tried to eliminate carbs, the more I thought about and craved them.. and the more weight I’d gain.

Each time I tried and failed, I was ashamed and felt like a miserable failure. I spent decades scared of my own growing body!

Since “we are what we eat“, I felt like I was bad because I couldn’t stop myself from eating bad stuff. Thoughts like, “you’re a failure, you’re so stupid, weak, pathetic, disgusting!” ran through my head a million times a day. 

His low carb diet rules destroyed my relationship with food, started a 2 decades long battle with my weight and my already low self-worth ended up even lower. By the time I was in my early 30’s I was borderline morbidly obese and haaaated myself and my body.

In 2007, “clean eating” entered my life and within 4 days of trying to follow “clean eating” rules, I had my first binge. The following day, my first compensatory behaviors emerged – I starved myself and exercised for about 3 hours to “make up for it”. Overnight, by doing what I was supposedly “supposed to do” to “solve my weight problem”, my mental health was trashed, just like that. 

Within 8 months I was sitting in a therapists office, hearing the word bulimic come out of his mouth while bawling my eyes out & begging him to tell me why I couldn’t control myself with food. 

We’re taught that perfect bodies are the only bodies worthy of love and goodness and the rest… well, the rest must be shamed and blamed into conforming.

We’re taught that gaining weight makes us bad and losing weight makes us good.

That’s a message we all promote loud and clear every single time someone loses weight and we celebrate them like they just won a Nobel. (but what happens & how do they feel when they regain it – like 95-98% of people who lose weight always do?)

So we punish ourselves with decades of dieting, severe calorie restriction, binge eating (the result of feelings of shame and dietary restriction), over (or under) exercising, and a horribly abusive inner dialogue – without even realizing those things and that world, all just making it worse.

Personally, at my heaviest, I was borderline morbidly obese for my height – and while I WAS dieting and trying to “stick to” exercise – I just kept getting heavier.

Like many people, I started dieting at a healthy weight and “dieted” my way to obesity.

And then, also like many people, dieted my way to an eating disorder. Sure, eventually I did manage to lose the weight and become a “success” story. But that’s ridiculous rare (only about 2-5% who lose weight ever actually manage to keep it off). 

We have GOT to change our definition of success around this whole weight conversation.

Weight gain is not failure and weight loss is not success. Especially when so few actually keep it off and so many end up with eating disorders that almost kill us. 

The sickest thing of all is that in our culture, that’s okay – because it’s better than still being fat, right?

No.

I carried shame with me every where I went like a 100lb weight wrapped around my neck. I felt like I was the only one who hated myself and couldn’t control myself with food, or “stick to” anything.

I thought I was the only who treated my body like a garbage dumpster, the only one punishing myself in that desperate attempt to make my body conform into something considered acceptable.

I thought I was the only one using food to so desperate try to fill a hole that I couldn’t quite identify.

I thought I was the only one who spent decades in the disordered eating world of serial dieting, and getting up every morning vowing that “today I’m going to be good!”only to hate myself for caving and eating a cookie or something by mid-day.

I thought I was the only one who stood in the mirror using words like disgusting, fat slob, gross, and worse when I’d see my reflection.

But I wasn’t. 

There are millions.

Trust me when I tell you this – people who struggle with their weight ARE TRYING TO DIET AND EXERCISE THE “PROBLEM” AWAY. 

It isn’t working. We have to stop telling everyone that’s what they need.(I wrote an ebook that talks more about why it’s not working. If you want a completely free copy, email me: roni@ronidavis.com)

75-97% of women report having unhealthy thoughts, feelings or behaviours towards their bodies at least once a day. 

That is a whopping majority of women who already believe there is something wrong with their bodies. They don’t need you, or Bill Maher or their doctor, or ANYONE else reinforcing it.

How, as a society, did we ever come to believe that the answer to physical or mental health is walking around living with shame, unhealthy thoughts, feelings or behaviours and hating ourselves for not being good enough because of our body size?

It’s ridiculous.

And we just keep passing it on to each new generation.

80% of 10 year old girls report having been on a diet and more than half of girls as young as six report wanting to be thinner. 

The scariest part of that is that studies also show the younger a girl is when she starts her first diet, the more likely she is to engage in extreme weight control behaviors (get an eating disorder), gain even more weight, struggle with her weight her whole life, and even abuse alcohol by the time she’s in her 30’s.

The average woman makes 3-4 (unsuccessful) weight loss attempts every single year for her entire adult life. 

Of the rare few people who actually lose weight when they go on a diet, as many as 98% regain it all and 2/3’s of them will weigh 11lbs more than when they started within 5 years.

Here’s the thing and I want to make sure this point is made loud and clear:

WE HAVE BEEN TRYING TO DIET AND EXERCISE THE PROBLEM AWAY.

It ISN’T WORKING. It’s making people gain even more weight over time. 

We have ALL grown up in this diet obsessed culture that taught us 1) weight loss equals success and looking amazing, 2) all weight gain is equally bad… very bad… and needs to be “fixed” 3) it’s the result of being too lazy to “fix” it, unmotivated, weak-willed, having no self-control and 4) you fix it with shame, blame, willpower and band-aids that actually make things worse

It’s all lies and it’s NOT working.

Diet & exercise advice is NOT working.

Blame and shame is NOT working.

Tens of millions of people are dieting every single year and have been for generations – weight watchers has been around since the 50’s. Atkins since the 80’s or 90’s. 

The weight loss industry has been doing nothing but growing and along with it, so has the population. 

That’s not a coincidence. 

It’s NOT working.

Diet culture is built upon the back of weight stigma and promotes fat-shaming, fear, and distrust in ourselves. It feeds on our insecurities and fuels the story that we are only worthy of love, acceptance and goodness if a scale displays the “right” number or we eat the “right” things and that happiness is only found on the other side of the next diet promising miracles.

And it’s all making our population MORE unhealthy. 

This isn’t just a mental health issue, but a social justice one as well – weight stigma & fat shaming remains one of the last socially acceptable forms of discrimination in our society and diet culture has made it not only accepted but even normal and expected.

As James Corden said, it’s bullying but worse, it’s socially acceptable bullying that’s hidden under the guise of “just caring about people’s health”.

But it’s not acceptable, it’s not helpful, it’s most definitely deeply damaging our physical and mental health – and it’s making weight gain worse. 

Traditional wisdom is based on a misguided fear that if people feel too good about their bodies and themselves, they will not be motivated to engage in healthy behaviors. 

But what we now know is that the opposite is actually true. 

There are strong, negative associations between internalized weight shame and poor mental that include 2.5 times higher levels of depression and anxiety. As well as, lower self-esteem, disordered eating, eating disorders, increased binge eating, and just overall worse mental health-related qualities of life.

1 in 4 people who diet to lose weight, end up with an eating disorder – a number that’s doubled in the last 20 years. And eating disorders have the highest mortality rate of all mental illnesses.

Further, higher levels of weight bias internalization are actually strongly linked with worse physical health as it creates lower motivation for healthy behaviors, worse adherence to healthy eating attempts, worse weight maintenance, and more. 

We are simply more prone to self-sabotaging, self-punishing, and unhealthy behaviors that actually promote more weight gain when we experience the bullying that is, fat-shaming. 

The bottom line is… there are severe mental health consequences of fat-shaming and weight stigma and they become cascading effects on mental and physical heath as well. 

Just imagine for a second if we stopped all the blaming, shaming & judging.

If we all just collectively stopped obsessing over body size or what our bodies looked like and started actually just focusing on how we feel in our bodies? If we focused on how our choices were making our bodies feel and on WHY we made choices that make it feel like crap?

I don’t want one more woman to destroy her mental health in that ridiculous war with her body and her scale. I don’t want one more little girl’s life to be destroyed by an eating disorder because someone taught her she had to be skinny to be worth anything and that food rules and restrictions were the key to health, happiness and self-worth.

If the diet and exercise solution worked the planet would be skinny and happy by now. 

It’s not working because it completely ignores the brain – the WHY behind the hundreds of auto-pilot choices we make every day. 

Behavior and habit modification doesn’t happen with blame and shame and it doesn’t happen by trying to force willpower and motivation for “sticking to” a bunch of strict food rules that accompany diets or trying to force ourselves to stick an exercise program in the hope that maybe someday a few weeks or months from now, if we’re just good enough and follow it, it’ll make us skinny. 

Habit and behavior modification happen at the brain level – because our brains control everything.

They’re controlling the things we tell ourselves about ourselves, they control everything we think, everything we feel and every choice we make – and much of the time unconsciously so we don’t even realize they’re doing it.

THEY are the greatest determiners of the quality of our lives and our health – and they are where these beliefs live in us.

The reality is, we can have a society that continues judging, shaming, blaming and ineffectively band-aiding symptoms while feeding a multi-billion dollar industry at our own expense but is that really what we want?

I sure don’t. 

We have to love, respect and value allbodies… unconditionally because choices made from love, respect and acceptance are 100 times healthier than choices made from shame and hate.

Imagine the difference that would make… if we lived in a culture that didn’t even think about weight. 

A culture that just focused making choices from a place of love, self-compassion and acceptance.

If we had a culture that promoted healing our wounds instead of creating bigger ones.

If we had a culture that promoted befriending ourselves and our bodies, no matter what size they are.

If we had a culture that uplifted everyone within our orbit, rather than tearing them down.

That’s what we need.

The truth is, if you truly care about people’s health, you’ll start becoming part of the solution rather than continuing to remain a huge part of the problem that is fat-shaming.

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If you’ve been struggling with food, dieting, your weight, and the shame that accompanies those things, help is available. Visit http://www.ronidavis.com/stonesfor more.

Roni Davis

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Travel Medicine Conference Notes

This past Spring I had the privilege of attending the 16th conference of the International Society of Travel Medicine in Washington D.C. Among the interesting topics of the conference were talks about first aid kits (by Sheila Seed), natural medicines (Karl Hess and Derek Evans) and avoiding insect bites (Larry Goodyear). Canada’s own Sherilyn Houle (columnist for Pharmacy Practice + Business) also presented on how we as pharmacists can integrate travel medicine into our practices. All were great talks that helped pharmacists bring their patients up-to-speed in keeping healthy during and after travel.

I find it can be worthwhile to attend a CE session even when you think you know all you need to know about a topic. Often, doing so will will reinforce your confidence in what you are telling your patients; but you may also learn some interesting new ideas that you can add to your tool box to inform patients. 

Having said that, many of the points reviewed during the conference reviewed common discussion topics—the things we would typically tell our travelling patients. Of course, the advice errs on the side of caution, keeping in mind that people may not be able to access any treatment at any given time while travelling. While the standard travel consult advice often includes assuming the patient will be dropped in the middle of the desert, common sense tells us that it’s possible to streamline their medical bag with a sit-down discussion that includes a plan for their actual destination. 

Commonly-mentioned talking points for a travel consult include: pack meds in your carry-on bag; bring something for travellers’ diarrhea, nausea, pain, UTI and yeast infection, and pack plenty of sunscreen.
One important note is to add tweezers to your patient’s travel kit for safe removal of ticks, splinters or other items that may become embedded into the skin. And although as pharmacists we should always promote vaccines, this is especially true with travellers. I always have the most up to date edition of the CDC Yellow Book for recommendations to patients who are travelling, and most of us have customers who travel. Whatever helps to make you the “go to pharmacist” promotes your brand. Although as pharmacists we should always promote vaccines, this is especially true with travellers.

Latest research on natural supplements for travel

Natural supplements was a big topic at the conference. Here are some key takeaways:

Altitude sickness:
 Garlic, ginkgo biloba and vitamin E have been researched for their antioxidant and antiplatelet effects. None have been proven effective and all have an increased risk of bleeding or hemorrhagic stroke. (Source given was Micromedex and CDC Yellow Book).

Common cold while travelling
: Echinacea, vitamin C and zinc are often asked about. 1-3 g daily of vitamin C, and zinc 9-24 mg daily (gluconate) have been shown to reduce the duration of the cold by 1-2 days in studies. Echinacea may reduce cold risk by 58% and reduce duration by 3 days. (All info based on CDC Yellow Book and Natural Medicines Database.)

Insect Repellents: Riboflavin and thiamine were both shown with negative results. Garlic dosed at 1200 mg daily for 8 weeks showed a reduced incidence of tick bites, but no supporting evidence for other bite sources. (Source: Natural Medicines Database for all)

Jet Lag: Fairly good evidence here for kava, melatonin and valerian. Kava’s rationale is as an anxiolytic and shows evidence for 100mg-200mg for anxiety associated insomnia with a safety issues involving hepatotoxicity. Melatonin has been researched here for alertness and daytime fatigue/performance. Melatonin at 0.5-5 mg at bedtime has been shown to be beneficial for eastbound flights over 5 or more time zones. It is unclear if this effect happens in westbound flights. Valerian has been tested for its possible effects on sleep quality and sleep latency. Using 400-900mg 2 hours prior to sleep is generally well tolerated and may improve sleep quality by up to 80% and decrease sleep latency by 14-17 minutes. It should be tapered if used for long periods of time. (references cited were Micromedex, Natural Medicines Database and CDC Yellow Book).

Motion Sickness: Ginger and pyridoxine. Ginger at 500 mg-1000 mg 4 hours prior to travel has shown conflicting subjective improvement in both nausea and increased latency before onset of nausea. Pyridoxine dosed at 10-25 mg every 8 hours has no supporting evidence for motion sickness (CDC Yellow Book, Micromedex and Natural Medicines Database)

Prebiotics and probiotics in travellers’ diarrhea: To say the least, study results are all over the map. Early studies and meta-analysis showed safe and effective conclusions in studies. We became aware of the need for specific strains in making recommendations. This makes meta-analyses difficult because of the number of strains tested. A specific prebiotic, B-GOS has been shown to have positive results in travellers’ diarrhea, especially if started a week before the trip. I personally recommend saccharomyces boulardii in prevention. 

Mosquito repellents: When it comes to mosquito repellants, don’t mess around— use DEET at the highest concentration available (i.e. 50%). Apply 0.5-1g per arm (1mg/sq cm). Nets treated with a pyrethroid have excellent evidence for efficacy and disease prevention.

Those are just a few highlights that may be helpful in your consults with patients preparing to travel. You don’t have to label your pharmacy as a Travel Medicine Clinic to be helpful to your customers. Regardless of your current level of comfort in making travel recommendations, I would highly recommend attending an International Society of Travel Medicine conference (with which, by the way, I have no connection or affiliation). You may convert a perceived niche offering into a welcome strengthening of your pharmacy toolbox.

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Look to Consistency for Understanding your Weight.

We’re bombarded with weight loss and diet advice every dayand everyone says the same thing about theirs – “scientifically proven”, “best way to burn fat”, “easy to follow”, “secret fat burning system”, “lose stubborn fat and keep it off”… literally, they all claim the same things.

Yet, most people who start a diet fall off it before even losing any weight and 95-98% of those who do lose weight, regain it all within a year and as many as 2/3’s of them will be even heavier than when they started within 5 years.

So, what’s with that? Do they work or not? 

Yes. And most definitely no. The truth is, ANY diet that puts you in a caloric deficit, IF consistently followed for long enough, will result in weight loss. Yes, ANY diet that puts you in a deficit. You don’t even need to do a “diet” …as long asyou’re eating less than your body is burning, you will lose weight. 

Despite their claims, multiple meta-analysis of long-term diet studies have shown that no one diet really works a whole lot better than any other in terms of how and how quickly they help shed body fat – there’s often not much more than a 1-3lb difference between them.

And, ANY diet that you consistently continue to follow AFTERyou reach your goal, will help you keep the weight off – again, no one diet really works any better than another here either.

Notice the key point in those two truths? 

Consistency!

Without consistency, they are all completely worthless – actually, worse than worthless. Dieting often causes a whole host of other problems, both mental and physical, in a large majority of people.

So, CONSISTENCY is the biggest factor in determines whether or not you’ll be successful at losing weight and keeping it off. Without it, nothing will work. With it, just about anything will.

But consistency is the exact thing that people struggle with most. That’s why so many people spend so many decades hopping back and forth between dozens of different diets – trying to find that magic one that they can FINALLY be consistent on. 

But it rarely works.

There are several reoccurring themes I’ve seen over the years that most commonly keep people from being consistent.

The seven biggest ones in no particular order are:1. Habits. Our brains are incredibly complex and have, since the beginning of time, been designed for survival. They have all kinds of annoying little tricks to make sure we stay alive and our habit center is one of them. What’s the first thing that happens when certain foods are off limits? Pretty much the second you decide a food is off limits you suddenly can’t stop thinking about it and craving it, right? That’s a survival instinct that’s literally been hard wired into our brains since the beginning of time. Food equals survival so when food restriction is introduced, our brains get scared and start trying to force us to “cave” and eat that thing we think we’re not supposed to have. Then, when we finally do cave, our brains get rewarded because they love food! That’s when the habit center kicks in and start wiring the cycle of craving and caving as an auto-pilot habit that we don’t even really control after awhile. The more you do it, the more you teach your brain that cravings = rewards and the harder it becomes to “stick to” anything. Have you noticed that when you first started dieting it seemed easier to stick to them and the more years that have passed the harder it’s become? That’s why. The longer this cycle repeats, the more ingrained the act of “caving” becomes. This is one of the biggest reasons most people struggle with dieting – because diets, especially the super restrictive fad ones, are SO restrictive of food. It’s also why eliminating food rules & restrictions is required.
2. Self-sabotage from limiting beliefs/the way we feel about ourselves. When we don’t trust ourselves or believe in our ability to be successful, we self-sabotage – because why on earth would we keep going when things get tough if we don’t think we can do it anyway? If we’ve already decided going in that we’re just going to screw up because we always do, we’ll just keep quitting as soon as it gets tough or inconvenient.Also, when we don’t like or love ourselves, we self-sabotage because we don’t believe we deserve to be successful. Unless and until you change those things, consistency will always be a struggle.
3. The change model. Again, another fun little trick our brains play on us because of their faulty programming. It’s a normal cycle when we’re trying to change because our brains do NOT like change and do everything they can to keep the status quo. So, the change model looks like this: First, there’s the discontent. We don’t like something like say our weight. Second, the breaking point. This is when we can’t take it anymore and brings us into the next phase of the cycle, the declaration. “This is IT this time, I’m really doing it!” which brings us to the next phase: fear. When we start doing things differently and our brains get scared. Remember, they don’t like change so they start making up a bunch of things for us to be afraid of. When it gets too overloaded with fear, it kindashuts down which brings us to the next phase in the change model: amnesia. This is where we start forgetting why we wanted to change in the first place. The goals we set weeks or months ago start feeling completely unimportant and we just stop caring about them. Which leads to back tracking on any progress we may have made while we slip back into the old habits that are brains are comfortable with.. until we start to feel that discontent again and the cycle just keeps repeating. The change model: Discontent > breaking point > declaration > fear > amnesia > back tracking > repeat will just keep replaying until you recognize it for what it is and learn to manage it.
4. Fear. Fear is a huge reason we struggle with consistency. Not just because our brains don’t like change but often, carrying extra pounds often makes people feel safe – if there’s a history of physical or sexual abuse, this is especially true. Often people who are struggling with their identity will also feel safer with extra weight because it helps them feel more invisible. No matter where the fear is coming from, it will cause self-sabotaging behaviors if you’re not aware of it and don’t have a plan to manage it.
5. Emotional eating. Some level of emotional eating is pretty normal for most people on occasion but if you’re someone who relies heavily on food for everything, whenever you’re bored, or stressed or upset, or anything… you’re going to keep falling back on your go-to copying strategy and consistency will suffer until you learn to change it.
6. Don’t want it bad enoughThis is a really common one. If your why isn’t big enough, if you don’t want it badly enough, you’re going to struggle with consistency every time it starts getting hard.
7. The weight centric paradigm that defines successThis is something I’ve seen derail SO many people – defining success based on what the scale says and nothing else is such a fundamentally flawed premise. What do we often say to ourselves when the scale doesn’t say what you want it to say one morning? 
This sucks, I’m never going to get this weight off, screw it, I’m eating whatever I want today.” 

Or even if it goes farther in the direction we want it to than we expected.. “Oh wow, I’m doing so awesome, that’s more than I thought I lost… I deserve a treat!”  which usually ends up in overeating.
The other reason that the weight centric paradigm is flawed is because it’s terrible motivation. Trying to force yourself to eat in a specific way today because maybe at some point down the road from now it’ll make you skinny and happy is terrible motivation to change eating habits that almost never works. Today you doesn’t really care about what the next week you is going to look like, today you just wants to eat what you want. There’s no immediate gratification when we live from a weight centric approach.
But switching from that weight centric model to focusing on how you feel changes everything because there is immediate gratification there. The things you decide to eat right now, will either make your body feel good or make it feel bad. If you’re trying to force yourself to eat what someone says you’re supposed to eat in order to make the scale go down at some later date, you lose sight of what your body wants and needs. It all becomes a fight over what you’re supposed to eat versus what you think you want to eat because your brain’s survival instinct is driving cravings. If instead, you start learning to trust your body and just asking yourself, “how will I feel if I eat that?” and “do I want to feel that way?” you start learning that your choices impact you right now and the more immediate the reward or the consequences, the more likely you are to be consistent.

I created cognitive eating to help address all those reasons and more. If any of that sounds relatable and you need help navigating your way through changing it all, you can contact me or find more info on the Cognitive Eating Academy here.

Roni Davis

We are lucky to have partnered with Roni in helping patients with their weight loss issues. Contact us for more information.

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Are Your Thoughts Creating Your Results?
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There are many reasons that people struggle with their weight and food for their entire lives – their thoughts are right up there among the biggest. 

I have seen this scenario play out a million times in people everywhere — hell, I lived it.

Our thoughts are creating our results. 

You look in the mirror in disgust. That prompts the thought, ‘I’m disgusting’. That thought creates a corresponding feeling of inadequacy (or even hatred) for not having “willpower” or for being so “lazy” or for not being able to “stay on track”.What kind of choices do we make for things we hate? NOT good ones. NOT choices that are in our best interest. So, those feelings create negative actions towards the objection (in this case the thing we see: our body). We slam it with insults, berate it, punish it with either more restriction or go in the other direction and binge on stuff that makes us feel like crap – and we give up on it (and ourselves) until the next time we get motivated to try again when the same old cycle just keeps repeating itself. 

Or we see the scale go up a pound and think, “I’m such a screw up, I’ll never lose this weight.” That thought makes us feel terrible and makes us either try to restrict further (which almost always ends in overeating) or giving up and eating everything the rest of the day.

The result we’re getting on the outside with our bodies is merely the result of the actions we’re taking because of the thoughts and feeling going on IN us. Our body didn’t decide to starve itself because the scale went up 2lbs and our body didn’t decide to punish itself by chasing a half gallon of ice cream with a bag of potato chips and two glasses of wine because we had a crappy day and are feeling bad about ourselves.

And our hearts are so tired from fighting the same war it’s just looking for ways to numb itself.

That’s why we keep getting the same result. There’s not a single diet on the entire planet that can fix any of that. They just make it worse.

Notice the contrast in this second graphic below…

If we work on switching the thoughts, we can switch how everything turns out.

Positive thoughts create positive feelings. And how do you treat something you have positive feelings about? You treat it with kindness, and care.

Actions based on kindness and care create, you guessed it… some pretty awesomely positive results. ?

Ending the war with food and our bodies, actually trusting ourselves, being mindful and present in our bodies, listening to them and honoring their needs changes literally everything.

And it starts with taming your inner critic, changing your brain and your thoughts—not another diet.

Your brain controls everything so change that and absolutely everything changes.

Can you relate to any of the thoughts I discussed and want help changing them? Check out the two new mindfulness based cognitive behavioral courses available and see which one fits you best. 

Roni Davis for Stone’s Pharmasave, Baddeck, NS

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Why do so many people struggle with weight loss or eating healthier? Guest Post by Roni Davis

What I used to think:There’s so much wrong information out there, most people just don’t know what they’re supposed to be eating and when. I have found the clean eating answer that everyone needs!

What I now know:Knowing what we’re “supposed to” be eating is soo NOT the problem. There are literally billions of pieces of nutrition and healthy eating content in the world and hundreds of thousands of people sharing their recipes and magic secrets about what they believe is the healthiest way to eat (and have you noticed, they all contradict each other?) – but most people still just aren’t doing it with much consistency.

Lack of information is not the problem. 

How many times have you “started over” vowing to “be good this time” only to end up “screwing up again” and keep saying to yourself, “Why am I so stupid? Why do I keep doing this? Why do I keep screwing up?”

You have all the information you need. Even if someone has literally told you exactly what to eat, how much and when to eat it …but you’re not doing it. Why?

What is the problem? What’s driving the consistent self-sabotaging behaviors? 

Disconnection from the wisdom of our own bodies, habits that have been hard-wired into our brains and the relationship with have with ourselves and food.

Those are the reasons behind why we eat the things we eat, the way we eat. Those are the things driving our choices. You can start a new miracle diet with different food rules every single day from now until the end of time but if you just don’t care enough about yourself to change, or if you’re using food to punish yourself or to numb emotions or to try to control everything around you, nothing is ever going to change about the way you eat because you’re not changing the WHY, you’re not changing the subconscious driving forces behind your choices.

One more time to let that sink in: KNOWING what we’re “supposed to” be eating isn’t the problem – the subconscious driving forces behind our choices is the problem.

That’s the key we keep missing.

Changing hard-wired habits and the relationship we have with ourselves and food, is the key to changing the way we eat.

Dig into your own whys with Mindful Movement or Cognitive Eating, two new programs available through Stone’s.

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The Value of Pharmacy Research

Boost Your Professional Credibility & Contribute to your Profession with Research

Practicing pharmacy has proven for me to be much more than I had planned when I was accepted to Dalhousie University’s College of Pharmacy 30 years ago.  Of course it created a career where I used the most available evidence based treatments for just about any medical conditions that I was asked about.  This degree put myself and my colleagues on a level that resulted in more people listening to us and taking our recommendations than we had ever experienced in our lives before.  All of a sudden, with such a degree on our wall and a license to our name, people would follow our beliefs without question.  Pharmacy can be a powerful profession with regard to public credibility, even when it involves treatments that have very little evidence or no evidence (such as homeopathy).  The mere presence of a treatment in a pharmacy and the recommendation of a pharmacist is all the public needs to blindly follow us in many cases.

We normally aren’t asked or required to supply randomized placebo controlled trials to back up our recommendations in the front store nor is that commonly asked for in our prescription world either.  Most of us simply give recommendations without readily knowing off hand any particular study that backs up what we are saying at all.  Giving public presentations may be an opportunity to show an audience where the foundation of our claims come from in the scientific world.  It turns out that the public can be information nerds like we are sometimes and are quite interested in presentations like this.

As pharmacists, we are tied to the study designs of others when it comes to our recommendations.  The weakness of their designs becomes the weakness of our recommendations.  For years we recommended docusate sodium as a stool softener, only to hear that it really doesn’t do what we claimed all these years.  10 years ago I was lucky enough as an owner to pursue a niche in compounding, a subset of pharmacy I was exposed to as a student working in a pharmacy a block away from the College of Pharmacy in Halifax.  Pain compounding became the focus of my practice.  The evidence for these ingredients was positive but didn’t involve hundreds of thousands of patients.  It consisted of many smaller studies that together added up into a strong base from which to recommend this treatment modality.  Active ingredients like amitriptyline, clonidine, gabapentin, ketoprofen, ketamine and lidocaine were all mentioned in the literature, but something was missing for me.  In order to put some stronger faith from the public in this, I needed to show some way that I was in some way involved with the evidence base of treating people this way for pain.

Turns out, universities are eager to showcase their research and are very helpful in sourcing out grants to fund scientific studies.  It has always been a drawback for a situation to exist in scientific study whereby the “promoter” that stands to make money is funding and driving the study forward.  However when we consider that this is how most prescription meds came to market it becomes more acceptable.  I believed it would be a strong asset to show that I spearheaded a study through my pharmacy that proved for the first time the permeability of these six ingredients through the skin would happened simultaneously.  A visit to the local university and they helped us with the application procedure for a grant that covered the cost of the study, new equipment included.  The money went completely to the lab with our pharmacy handing over three sample creams in three different bases.  With very little effort on my behalf, I went from wanting to prove I could drive these molecules through the skin to having a typed manuscript with graphs showing flux over time that I could bring to prescribers and show to recipients of the cream to instill confidence in their medication.  This completed study is soon to be published.

As a follow up, we applied for and were accepted for a grant with the local pain clinic to use the same pain cream with the local pain clinic on 40 patients with nerve pain.  What better way to put your money where your mouth is than to put your own hand picked ingredients on the spotlight and test whether or not they actually work.  We were that confident based on hundreds of patient results.  

In another study, we partnered with The Propel Centre at The University of Waterloo to supply data on the aftermath of discontinuing the sale of sugary beverages at our pharmacy in 2014.  In this case they approached us on starting this study, which was finally published in 2016 and became the subject of a Thesis presentation after that. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4947263/

My point is, based on the funding available out there, why not take a treatment concept you either feel strongly about or want to clarify that has been conventionally accepted for years (either prescription or non prescription) – lots of opportunities exist in the front store here without taking on big pharma. Meet with the university scientist that will design the study and share your thoughts on what you are trying to unveil. Allow them to introduce you to the grant application personnel, (or vice versa).  It becomes an incredible strength to refine your knowledge of study design you’ve learned from your pharmacy degree.  You don’t have to be an expert on study design.  Allow the researcher you are collaborating with to develop the study with your input.  Nothing beats having your name on a study that shows that you are so committed to your profession and your recommendations that you are willing to be involved in an actual study to clarify our understanding of a topic.  Being known as a research pharmacist gives extra credibility to your commitment to your profession as well as increases your knowledge base for your recommendations to your patients and your physicians.  Your contribution to your profession will not go unnoticed, and the next time a customer asks you if you are aware of any studies on a particular topic, you just might be able to quote one directly.

Graham MacKenzie Ph.C.


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Healthy Aging in a 103 Year Old Customer
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Most Pharmacies have a patient (or more) that is a centenarian.  Living to the age of 100 is quite an achievement, considering these patients grew up and lived the prime of their lives in an era that had a healthcare model quite different from today.  Knowledge of how diet, exercise, nutrition and medicine interplay to result in a long life wasn’t as advanced as it is today.  Some may say the diet 100 years ago was superior to today’s diet.  They probably wouldn’t be wrong.  Sanitation, pasteurization, and crop control were at a different stage at this point in time than they are today.

I had the pleasure of sitting down with Margaret MacPhee, 103 years old from Baddeck, Nova Scotia recently to ask her what her life experiences that may have helped get her to this age.  In an interview that was hopefully not patronizing, she opened up about her life from childhood to today.

Margaret was born at home during the wintertime of 1915 and grew up in a house in Upper Baddeck (Big Baddeck) the fourth oldest child in a family of 11.  She wonders how she managed to be living at all growing up back then let alone survive to be 103.  Her house had no electricity or phone and was heated from one central stove.  Her father was a farmer and her mother “had lots to do with all the children”.  This was not uncommon for the families that grew up in the area as every family seemed to be large.  She went to school in Upper Baddeck for 11 years then went out working from home to home in the area doing housework.  She was married to Charles D MacPhee in 1946 until he passed away in 1992.  They had one daughter (Catherine), a large difference from her family size growing up.

Margaret didn’t smoke or drink alcohol during her life.  She didn’t recall taking any type of vitamin or herb growing up.  As a child she doesn’t directly recall most of the healthcare or medicine of the time.  She recalls early in her life coming home from Sydney and then coming down with Scarlet Fever.  She doesn’t remember what Dr MacMillan gave her at that point but she survived this.  She clearly tells about being quarantined alone in her room where her mother soaked a blanket and hung it in the doorway of the room to keep the germs from spreading to the rest of the house.  Given the lack of modern day entertainment sources for children back then, it must have been a lonely time for Margaret during the long hours of the days and nights while she recovered.  No one else came down with the disease in the house.  She also had measles and as well had whooping cough, which she recalls almost dying from.  She lost a brother to the whooping cough (a twin of another brother).  Another brother died from croup at a just a few months old.  There were no vaccines at this point for them of course and routine visits to the doctor weren’t all that common unless there was a need.  Given the lack of antibiotics and vaccines back then, childhood was a journey with pitfalls not seen today that made it more of an accomplishment to get to adulthood than it is now.

When asked of her sleep habits she says, “now I’m sleeping all the time.  If I lay down at all I’m asleep!”  She says living as a young girl on the farm you were up early to do your chores and then get ready for school.  When you came home you started into the chores again.  There were three meals a day, breakfast and supper and home and lunch was taken to school.  Food eaten back then was grown on the farm.  Herring and codfish were also staples as were beef and pork from the farm.  Whole food was the norm. Processed and ultra-processed food we see today weren’t the food choice back then living on the farm.

Margaret isn’t one for social media, and as mentioned,growing up they had no phone.  They burned kerosene lamps for light at night.  Electricity wasn’t something she had in a home until she got married and moved out on her own.  One of the biggest differences between then and now was the direct social network everyone had.  There wasn’t a night in the winter regardless of how stormy it was, that there weren’t people over at the house.  Family or friends and neighbors would visit until 11:00 at night every night.  A common activity was playing cards and it wasn’t uncommon for visitors to travel with snowshoes back home.  Picturing what it would be like with no power or contact with the anyone (TV, cell phone, social media, email or texting) makes it more understandable how long evenings were passed with groups of visitors every day. She says there isn’t anything like this today.  In fact we have seen survival rates from some diseases like cancer have a better survival rate when the patient has a better direct social network available to them.  If there was a storm, there were no plows but for two days after the storm everyone would be out with their horse and sleighs making a path on the road.

One of her earliest recollections in the house was a day when her father was out working, perhaps out in the woods, and her mother was out doing chores outside of the house briefly at noon.  She was left in the house with her two older brothers, one of them being in charge while she was out.  She recalls it being a stormy day, her mother was out feeding the animals and when she came out of the barn she smelled smoke.  Looking in the direction of the house her mother saw smoke coming from the house and chimney.  Her father smoked and instead of using matches he would use long thin sticks to light his pipe that he lit in the fire.  Her babysitting brother found some of these laying around and grabbed one and put it in the fire.  There was an open chimney behind the stove with bark, kindling, and papers in it.  He threw the stick in the chimney causing everything in it to catch fire.  By the time her mother made it back to the house, her brother had taken the younger brother out of the high chair and ran with him into the bedroom off of the kitchen and closed the door, leaving Margaret crawling around on the floor.  When her mother got to Margaret she was almost to the blazing chimney.  Her mother had her hands full.  

Today only two sisters, Agnes (Baddeck) and Marion (Sydney) are still alive.  Marion’s daughter was raised for a while by Margaret’s mother when Marion went to Sydney to work, so she thinks of her as a sister.  Her siblings lived to be in their 70’s for the most part.  Her mother died 4 months shy of her 100th birthday.  Margaret remembers her mother as being a hard working woman.  She wasn’t a nurse but she feels she could have been and would help deliver babies, was good around animals and people.  Her father passed away of a heart attack at 69 years of age.

In looking at what contributes to Margaret’s long life, we can certainly attribute her DNA passed down by her mother as being a major contributing factor.  There wasn’t a lot of money to go around the family growing up, but like the other families in the area they got through it.  Living on whole unpasteurized milk (not recommended today), curds, butter, cream, butter milk, vegetables and fresh farm raised meat.  Today she eats a little differently, margarine and 2% milk, and some processed food she might heat up in the microwave.  Aside from being forgetful with names, she is still quite active and comes into the pharmacy regularly.  A good sleep habit and regular physical activity are undoubtedly helping her to age in a healthy manner.  As a child and an adult, she had no cell phone to keep her up at night disrupting her sleep.  Finally, a strong network of other contacts that she regularly saw reflects the results we’ve seen in longevity from other studies.

Margaret has no major regrets looking back.  She supposes back growing up there were a lot of regrets of what she had to do but nothing lasting.  She recalls a story of two men in their 80’s for how she feels of this stage of life. One says to the other how great he feels and wakes up everyday wanting to take on the world.  The other one says he feels just the opposite.  He feels like a baby, “I have no hair, no teeth, and I just wet myself”.  Margaret also has a good sense of humor.

I’d like to thank Margaret for yet another down to earth talk with her and her willingness to share her experiences with everyone.  

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Pain Relief With Omega-3
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Omega 3 supplements have been taking a beating lately with regard to cardiovascular outcomes. One thing that we have seen is the questionable cause and effect of the wide variety of commercially available Omega 3 supplements available on the market and the dose required for any effect at all.

Clinically, one indication I see Omega 3 supplements used for successfully is pain relief. It works along the same pathway as anti-inflammatory medications. But what does the evidence tell us about the effectiveness of such supplementation in an era where vitamins, herbs and supplements are more and more becoming a punching bag for quackery? Is there hard evidence for treating pain without the use of (oral) NSAIDS, opioids, muscle relaxers, antidepressants, counterirritant rubs, and anticonvulsants? Transdermal pain compounding comes to mind, but is there an OTC product you can start today in giving your customers to begin safely reducing their pain?

First of all you need to set expectations. If you are someone in chronic daily pain, you need to be upfront with them as a pharmacist by telling them that 100% pain relief is not a concept that we entertain. Your discussion with goal setting with them should inquire what they want to get out of this. Most patients in chronic pain don’t necessarily need to be pain free, they have learned for years how to live and cope with pain. What they may share with you is the desire to play with their grandkids, to go to church with their spouse, to go for a walk with their dog every day, or to just simply get out of bed and make a meal for themselves.

There have been a number of pain patients I can recall who have claimed that by taking this one supplement, they are able to do some of these activities. As evidence-based healthcare practitioners, we must strike a balance between following anecdotal evidence we’re presented with in the pharmacy and using the invaluable clinical evidence we see as healthcare professionals that really no one else sees. This balancing act inevitably involves stumbles where we fall for an N of 1 to strongly and apply it to everyone we speak to. In other moments of clarity, we look back at the results of our recommendations and accumulate a non-trial-based clinical judgment that we feel strong enough about to make recommendations for in the front store.

Recommendations to use Omega 3 supplementation in relieving pain are based on good quality evidence. When we look at the use of Omega 3 with rheumatoid arthritis (RA) specifically, it is important to reinforce with patients (and to ourselves as pharmacists) that this is not meant to replace what we use conventionally. Disease modifying antirheumatic drugs (DMARDS)should not be dropped in favor of Omega 3 supplementations. In fact DMARDS can help induce the remission of the disease when used early. They can, however, be used in conjunction with them.

Being a disease connected with the immune system, rheumatoid arthritis treatments that work with the body’s immune system are an attractive way to combat the problem. Omega 3 has been shown to affect our immune system. Arachidonic acid, which is an omega 6 product, flows into pathways that create inflammatory molecules which are involved in rheumatoid arthritis, including inside immune cells. The EPA and DHA in marine Omega 3 supplements reduces arachidonic acid. They follow a pathway which results in anti-inflammatory products and affects dentritic cell and T cell function. Additionally, it reduces reactive oxygen species by leukocytes and inflammatory cytokine production by macrophages. But the work on this area and how it pertains directly to RA is less understood. (1)

In a systemic review of 23 studies of Omega 3 use, modest but fairly consistent benefits were seen in relation to joint swelling, pain, the duration of morning stiffness, and the global assessments of pain and disease activity.(1)  There was also a benefit in the amount of NSAID therapy used in these patients.

In explaining just how omega 3 has a cause and effect relationship with RA and how studies show that it helps to reduce pain, we look to the similarity in effect between NSAIDS and Omega 3 in the body. Prostaglandin E2 (PGE2) is involved in all processes leading to the classic signs of inflammation (redness, heat, swelling, pain and edema). (2) A typical NSAID blocks the production of Eicosanoids including several prostaglandins as well as thromboxane proinflammatory products involved in pain and inflammation. Omega 3 reduces the production of mainly PGE2. Therefore you get the benefit of reduced pain and inflammation while avoiding the other problems with NSAIDS on the stomach. Unfortunately, the blood thinning still occurs, so those at risk for bleeding or on blood thinners need to be mindful of this. In reducing the dose of Omega 3 to avoid this, patients may put themselves in a dose range that is ineffective for RA. As you may have guessed, Omega 6 supplements increase arachidonic acid which is responsible for the production of these pro-inflammatory products, so combination 3-6 or 3-6-9 products are not recommended.

Based on current data, doses above 2.7g per day of combined Omega 3 ingredients in the fish oil are required for this response, which may be delayed for two to three months before results are fully realized.(3)

A systematic review that looked at the effect of marine fish oil on the pain of arthritic disease determined that it did in fact reduce pain in that population (4). An excellent source for references comes from the Australian NPS MedicineWise from April of this year. Over all it lays out a number of encouraging studies that can put another tool in the pharmacist’s toolbox for helping your RA patient.

Looking back to our “front store experience N of 1 world,” Omega 3 supplementation and joint pain relief always remind me of my 101-year-old customer who reminds me that she wouldn’t be moving at all without this supplement.

Graham MacKenzie is a compounding pharmacist in Baddeck, N.S., and a graduate of Dalhousie College of Pharmacy.

References

  1. Miles EA, et al. Influence of marine n-3 polyunsaturated fatty acids on immune function and a systemic review of their effects on clinical outcomes in rheumatoid arthritis. Br J Nutr. 2012 Jun;107 Supp; 2:171-84
  2. Emanuela Ricciotti Et. al . Prostaglandins and Inflammation. Arterioscler Thromb Vasc Biol .2001 May; 31(5):986-1000
  3. Rees D, et al Dose-related effects of eicosapentaenoic acid on innate immune function in healthy humans: a comparison of young and older men. Am J Cin Nutr. 2006 Feb;83(2):331-42
  4. Senftleber NK et al Marine Oil Supplements for Arthritis Pain: A systematic Review and Meta_Analysis of Randomized Trials. Nutrients 2017.
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