Monthly Archives: August 2019

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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