I wanted to share a recent story about my experience with the Carnivore Diet and Low Insulin Lifestyle. Maybe it’s because I just finished watching Netflix’s Apple Cider Vinegar, but sharing my health experience feels strange: very health-influencer-esque. There is some mention of weight and weight loss and some mention of body image and my relationship with food, but that’s not really what the story is about: it’s about insulin. I know I’ve shared things of this nature before, and sometimes, weaving stories can add some humanity to what might otherwise be a cold and clinical onslaught of health information.
So, if you find the idea of reading about me intriguing or even entertaining, read on. As usual, remember that this is my experience and can’t be extrapolated to everyone. Let’s talk in a clinical setting if you read something that resonates with your experience and want to learn how it might fit your health history and goals.
Last summer, something shifted in my health. Maybe it’s the same thing that happens to most women around this age (late 30s), i.e., the catch-all explanation-replacement for “it’s just stress”-perimenopause. Maybe there was a shift in how I was taking care of myself, although it felt like I was staying on top of everything. I walked a lot, went outside, and ate fruits, vegetables, and protein. But something still felt off.
And the thing that felt “off” was what so many patients often complain about. I felt… well, I had gained some weight, and not just physical weight. I felt mentally and spiritually heavy. The weight seemed to pile on out of nowhere. I shun the scale and rarely weigh myself, but one day, I did. The jump in number was so big in such a short time that my judgey scale asked if I was the same person who had weighed in 3 months before. Wow. Nice…
The heaviness wasn’t without its causes. That Spring, I finished my Masters of Counselling Psychology–a long, almost three-year slog. Shortly after, my 15-year-old dog, Coco, stopped eating for four days. He was diagnosed with protein-losing enteropathy and put on a daily dose of liquid prednisone, a steroid. Coco has been with me from the start of all this, when I first filled out applications to attend naturopathic college. He slept beside me during late nights of studying. He came with me to my exams. The sleepless nights, the decision-making, weighing the responsibility of senior pet ownership–when to intervene medically, when to decide to end his suffering, of course, the sheer financial cost– was a lot to grapple with and went on for months. It’s still going on, to be frank.
That summer, my Nonna passed away a few weeks before her 97th birthday.
I wondered if it was grief, or stress, or even steroids getting on my skin, but I felt puffy. I was tired. I felt sluggish and less stress resilient. I was still active but doing more sedentary activities: reading and learning guitar.
Weight and digestive issues have been a struggle my entire life. The “healing journey” has led me on some valid paths: exploring food sensitivities and gluten-free living, nutritional support through supplements and nutrient-dense foods, meditation and mindfulness, adrenal support and herbal medicine, and prioritizing rest and mental health.
But, regarding nutrition, I felt I was doing everything I could. I didn’t want to go down the road of caloric restriction. I didn’t want to deprive my body or fight its process. Sometimes, weight is protection. Sometimes, we need a warm, heavy blanket. Sometimes, we need to slow down.
So, I did. Of course, I was tempted by thoughts of how to solve the weight gain by dieting, as so many of us have been programmed to do. I even recorded a podcast about retraining myself to value and preserve my muscle mass rather than trying to become smaller. I accepted this new shape and focused on the tasks: my work, hanging out in nature, surfing, and healing my gut.
My gut health was terrible, although I was managing it based on all the research I had sifted through on my way to creating a gut health course. I added in more fibre and fermented foods. This worked for a time but didn’t solve the problem entirely. For most of last year, my irritable bowel syndrome was wrecking havoc. I was highly distended, often in pain.
I had brain fog and physical sluggishness. I felt stuck in a parasympathetic state. So, I sat on the couch, enjoying slow mornings, reveling in the absence of deadlines. I read books. I went for long walks. That summer, I swam in lakes and went to the Atlantic ocean.
While trying to be patient with my body, I constantly felt that I wasn’t tapping into the energy from my food. I would eat a full day’s worth of food and some stews, legumes, rice, smoothie, and salads and still feel hungry. I was constantly thinking about food. I tried to honour this by just eating more whole foods. I believe the body asks for what i needs, if we’re willing to listen. So I tried my best to listen.
Around Christmas, I was at a cafe with my boyfriend. He was eating a sandwich. Ever since naturopthic college, I have diligently avoided gluten. But I was already feeling sluggish and bloated. I was already tired. And here was a delicious, bready baguette. A delightful sandwich with soft carbs, mayo, cheese, and meat, just inviting me to sink my teeth into it. What good was avoiding gluten doing me at this moment? I avoided gluten to feel energized, healthy and light. I already wasn’t feeling that way, so eff it, how could things get worse?
I took a bite. It was divine. I let myself eat gluten for the next month. Glorious, glorious bread! I felt like my life was straight out of the pages of Eat Pray Love as I gorged on all the pasta and pastries I wanted. I chilled at Christmas parties, eating brie, bread, cakes and pies. I had all the dessert. There were no limits anymore. And, in a way, that food freedom did heal my soul. It was like a vacation from all rules and guidelines. We need this from time to time.
But, if I was barely staying afloat before then, adding in the gluten and sugar made me slip below the surface. I was insanely bloated. My weight soared. I felt sore, stiff, and clumsy. I had significant brain fog. My ankles and face were comically puffy. While I didn’t regret a second of it, after my foray into the world of gluten, I decided it was time for a reset.
After much consideration, a light switch clicked on, and I decided it was time to try the Carnivore Diet.
The premise of the Carnivore Diet is that it’s the ultimate elimination diet. It’s ketogenic, or zero carb, and contains no FODMAPS (fibre), grains, or other allergenic foods. It gives the gut a chance to reset.
While we often hear about how good fibre is for us, the truth is that some research shows that eliminating fibre can heal constipation. Emptying the gut and consuming a low-reside diet, in other words, all the components of the diet are digested and absorbed early on in the digestive tract, can give the colon a break. Further, burning ketones can heal the gut as the primary ketone, betahydroxybutryrate, is food for gut cells (we often hear about butyrate in the context of eating fibre).
Advocates of Carnivore talk about appetite control, abundant energy, healthy digestion, clear skin and effortless ease in maintaining a healthy body weight. I wanted this. I also wanted to feel more connected to my body and its energy processes. I wanted agency over my food cravings. I felt my appetite was out of control and my body needed something it wasn’t getting or couldn’t access.
Within the first 24 hours of Carnivore, my brain fog lifted. After the first week, I dropped 12 lbs . It felt like emerging from the fog into sunshine, and tossing off a heavy cloak.
I felt fully nourished for the first time in a long time. I ate a lot of fat, meat, eggs and even dairy. I felt energized. My appetite calmed down. I woke up in the morning, and instead of rushing something down my throat, I made myself a coffee and felt hunger slowly creep in.
I would prepare a big breakfast of meat and eggs that would hold me until the mid-afternoon. The food noise died down. My brain felt supercharged- I could think again. Even after long hours of talking to patients or working at the computer, I felt my brain could keep going and going and going. I no longer got that white noise static electricity that I associated with oxidative stress caused by overworking my neurons.
My mental health was better than it had ever been. I felt calm, persistent brain energy and agency over my thoughts. I felt emotionally stable and resilient. Nothing seemed to phase me. I felt strong.
I felt great. My original intention was to do the diet for a couple of weeks, but after the first week, I thought, I can do this forever! This is my diet, it’s my way of eating, something about it felt right. It was also the dead of winter. What would I be surviving on if I were in the wild right now? No fruits and vegetables were around; the ground was covered in snow. I would be hunting and killing animals and surviving on their meat. This way of eating felt aligned with the season, and I believe it was what my body needed at the time.
My brain and body thrived on the ketones. I had no cravings. Even on my birthday, I just wanted a nice ribeye steak. I couldn’t care less about cake, potatoes, or any other exciting comfort foods we look forward to on birthdays.
It was hard to sustain the diet on vacation. When I went to Ecuador in late February, I decided to let go of Carnivore and eat what was available. Because of the sun, surf, walking and relaxed vibe, I felt good in Ecuador, but my body felt far from magical. I dealt with chronic gut issues, miserable period cramps and a three-day migraine throughout my time there. On the plane ride back, I was ready to restart Carnivore and found it relatively easy to jump right back in the following day.
I hesitated to talk about my experience on Carnivore even three months into the experience. I felt great. My body felt like an efficient engine, burning fuel cleanly. However, the food was all…well, brown. And salty. And I often felt dehydrated. Also, after the initial drop in weight, I had stalled.
Grocery shopping was a strange experience. It felt surreal to be surrounded by all this… food. Stuff that wasn’t a part of my day at all. It wasn’t the snacks or chips or candy or even the carbs that tempted me. It was the rainbow of fruits and vegetables that greeted me every time I wheeled my cart into the store.
The fruits were shiny and colourful, advertising their sweet, hydrating juices and vitamins. Glycogen, or stored carbs in our muscles and liver, hold water in our bodies. On a low-carb diet, we often burn through our glycogen stores. If there was one thing I craved on Carnivore, it was the sweet hydration of juice.
One day, I was browsing Instagram and saw a comment on a popular account about glucose regulation. The account features a biochemist/influencer who shows a series of continuous glucose monitor graphs and discusses the glucose response to food. Her methods feature tips like “add fat to your carbs to lower your glucose spike.” This post highlighted how adding fat to starches (like hummus, which adds fats like olive oil and tahini to starchy chickpeas) can reduce the height of a glucose spike, helping to regulate blood sugar.
This is something I often coach my patients on, as blood sugar regulation is the key to mood stability, mental health, cognitive energy, and adrenal function, among so many other things. Interesting how I was kind of wrong about that.
The comment that caught my eye was written by a PhD who pointed out that while adding fat and carbs together can lower a glucose spike, it does not change the height and area under the curve of the insulin spike. Adding fat to starches might make the insulin response to food larger, even if it’s curbing and controlling the rise in glucose. It hit me then. We’ve been focusing on the wrong thing. I assumed glucose and insulin were like two twins on a tandem bike. One rises, and the other one joins in. Seesaw, yin and yang. But I started connecting the dots from the cases of patients I’ve seen, my experience, and third-year biochemistry. Yeesh, it’s all about insulin.
I remembered something else, too: the Insulin Index.
88-90% of humans are insulin resistant. We can’t access our fat stores or the energy from our food because we have chronically high insulin levels and unresponsive cells. Insulin’s main job (or maybe its most famous job) is to help drive glucose into shelves. You consume starch, glucose explodes onto the scene, and insulin puts it all away for you. It stores the sugar as glycogen and fat, and your body burns those later for energy.
Naturally, whatever causes a rise in blood glucose will also cause a rise in blood insulin. But sometimes, glucose isn’t rising on a continuous glucose monitor because insulin has already lept onto the scene to bring sugar down. Further, some foods, like whey protein and milk, don’t spike glucose much but will have a (significant) impact on insulin levels.
The commenter, Dr. Ali Chappell, PhD, described herself as an insulin researcher. Her research involves examining the effects of a low-insulin spiking diet on PCOS (an insulin-resistant hormonal condition that affects about 10% of women). The Low Insulin lifestyle was tested on various women who reliably lost 19 lbs in two months without counting, eating as much fruit, non-starchy vegetables, nuts and seeds and animal protein as they wanted. When I discovered Dr. Ali Chappell, I had just been hired to do a course on Insulin Resistance, which involved researching the manifestations and solutions to keeping ourselves metabolically healthy.
While a low-carb or Ketogenic diet like the carnivore diet can certainly heal metabolic dysfunction, it didn’t feel right to recommend this lifestyle to patients. It wasn’t for the faint of heart, for starters, and something in my soul was starting to miss fruit and vegetables. As part of my course research, I began to dive deeper into the low-insulin lifestyle.
Some bells started to ring for me. At the same time, my good friend was struggling on Carnivore because, while she felt great, she was breastfeeding, and the diet was affecting her milk supply. I shared with her what I learned about the Low Insulin Lifestyle. She started on the diet and, within a few days, told me her cravings and hunger were diminished. She was dropping her weight-loss-resistant belly fat like a stone.
After she had been on it for a week, I followed. I was ready to add more colour to my life. I removed the whey protein and dairy I had been eating, thinking it was fine and not realizing it was impacting my insulin. I added more fruits, vegetables, nuts, and seeds. I had dark chocolate again!
The variety was lovely. My gut was ready for fibre again, particularly the soft, gooey, juicy fibres from fruit. It felt good to fill my stomach with bulk. And it felt terrific to eat so many colours and textures of food.
Weight loss that had stalled for months after that initial drop on Carnivore kicked up again. My appetite chilled out, and I felt nourished again. I realized this eating pattern had been something I stumbled on from time to time: my trip to Brazil in 2020, my first forays with Paleo, even following the guidance of a microbiome test I did in 2021. However, none of these experiences involved intentionally targeting insulin. I would often eat starches like sweet potatoes or rice. I sometimes cut out fruit, with its fructose, which has a minimal impact on insulin.
This finally clicked things into place for me. It helped create a framework to encase my intuition around food and what humans should eat.
I was consuming whole, natural foods our ancestors would have consumed. Unprocessed plants and animals. Lots of healthy fats. Lots of sugar from fruit. Phytochemicals from colourful plants. Protein and nourishing fat from meat, eggs and some yogurt or cheese. I ate berries and burgers. Salads, broccoli and asparagus. I had sausages with organic tomato sauce. So many bacon and eggs breakfasts. I had nuts and seeds and pumpkin seed butter. I had dark chocolate and bananas. Pistachios. Shawarma meat and salad (hold the rice). It was easy to make decisions and figure out what to eat.
Looking back, I think glucose intolerance has plagued my whole life. It has affected my body and my relationship with food. It led to years of binge eating that only stopped if I ate more consistently. Protein helped immensely.
When things started to feel off, I consulted with a family doctor. I ordered some bloodwork through her and did some myself. My fasting insulin levels and insulin sensitivity (HOMA-IR) value were normal. However, when we eat foods spike insulin, it can cause a post-prandial (i.e., post-meal) rise in insulin that can stay elevated all day, as we go from one meal to the next. It can spike hunger and cravings, causing us to eat and continue to boost insulin. While hyperinsulinemia can lead to insulin resistance, I don’t think my body was there quite yet. I was raising my insulin levels, blocking my body’s access to energy stores and driving the hunger, inflammation and heaviness I was feeling.
Insulin sensitivity and glucose tolerance tend to shift as our hormones change through our late 30s and 40s. As estrogen and progesterone levels change, insulin levels increase, and we become more insulin resistant. This explained that shift I felt. The old patterns of diet and exercise I was engaging in weren’t working either. I needed to be more intentional with the way I was eating and exercising.
I started adding in more resistance training, scheduling in weights and high intensity interval training two to three times a week in addition to my yoga, swimming, and walks. The carbs from fruit helped fuel my muscles. I felt myself shift out of that parasympathetic shutdown state. I watched my nervous system enjoy more flexibility.
In a few weeks, I will start filming my course on insulin resistance. Then, it will go to editing. I’ll let you know when it’s time for it to be released. The course has been a gift. It allowed me the space and time to dive deep into the research and start putting various bits and pieces together. Metabolic dysfunction is the great health crisis of our age. I’m becoming more and more convinced that it drives so many of the common concerns we see in natural medicine practices: SIBO and candida overgrowth, adrenal fatigue, estrogen dominance, and chronic inflammation. There is a whole budding field of mental health called “metabolic psychiatry” that examines the role that insulin resistance has on mood and brain health.
Until proven otherwise, if a patient is dealing with high insulin, we must address this as a potential root cause that ties together all their concerns.
The medical establishment often overlooks insulin resistance, as the primary focus is on diabetes, which represents a later stage on the disease continuum. Decades of dietary advice have also set us up for metabolic inflexibility and an overabundance of dietary glucose that overworks insulin and blocks our ability to use energy for brain and body health.
The good news is that I believe the solution is simple. Eat a diet that leaves insulin alone: animal protein, nuts and seeds, fruits, non-starchy vegetables and healthy fats. Leave aside the starches (grains, legumes, root vegetables) and sugar. Add in some higher intensity training and work your muscles. With this approach, we have the start of a full-blown health revolution on our hands.
Stay tuned for more podcasts and courses on this topic in the coming months!
I am excited to introduce a new podcast episode (I know it’s been a while). I’ve been deep in the weeds of research about insulin resistance for a course I’m working on (for a health education platform that I’m very excited to tell you more about in the coming months).
I came across Dr. Ali Chappell, PhD, when researching my course. She helped hit home for me this idea that we’ve been focusing too much on blood sugar when the real focus for better metabolic health, body composition (i.e., weight management), energy and mood needs to be on INSULIN.
For years, I’ve been telling patients to “put clothes on their carbs” by adding fat and protein to higher-carb meals to regulate blood sugar. I’ve also recommended whey protein for protein powders. I didn’t realize that this was the wrong approach for supporting metabolic health when someone is dealing with insulin resistance (as so many of us are).
While these foods and practices DO regulate blood sugar, they don’t minimize the root of blood sugar and insulin resistance issues, which is insulin spikes.
You might have heard of the “glycemic index,” which tells us how much a food spikes blood sugar. Well, there is also something called the “insulin index.” Dr. Ali Chappell, PhD decided to look more deeply into this concept when developing a lifestyle to treat her PCOS, an insulin resistance hormone condition, and the number one cause of infertility in women.
She found genuinely remarkable results in herself and decided to turn to science to test her theory.
In this podcast, we discuss her research done on women with insulin resistance and PCOS, who got incredible results, losing an average of 19 lbs and reducing their fasting insulin levels by 50% in 2 months -eating all the nuts, fruit, vegetables, fat and animal proteins they wanted. In this study, the women counted no calories, carbs, protein or macros. They just avoided foods that spike insulin. Very simple.
This research has been repeated three times, and a randomized control trial is set to be published soon. In this trial, the lifestyle was tested against conventional medical advice for PCOS and insulin resistance (eat less, exercise more, and take medication).
We talk about the science of insulin resistance and how food impacts insulin, why we need to start focusing on insulin as a medical community, and how to take back your life, manage your appetite, stop cravings–all the good things–so you can live your life with lower inflammation, better mood, and better energy.
We might have discussed this lifestyle plan if you’ve seen me in the past few weeks.
This podcast is a must-listen if you’re struggling with
Abdominal weight gain and difficulty losing weight
low energy
hunger and cravings
considering Ozempic or other GLP-1 medications
PCOS and other insulin-resistance conditions
have seen high insulin, high blood sugar, or high cholesterol on your bloodwork
have hypertension, insomnia, energy crashes throughout the day, irritability
inflammatory conditions (anything that ends in “itis”)
a family history of Alzheimer’s and dementia
a family history of cardiovascular disease
…and so on and so on- everyone can benefit as 90% of us are insulin resistant, and I’m becoming more and more convinced that conditions like “adrenal fatigue” or menopausal weight gain are due to elevated insulin levels affecting our bodies’ ability to get energy and burn fat.
I’m so excited that Dr. Ali agreed to speak with me, and I’m thrilled that she was so generous with her time and information.
On Thursday, June 20th, the Ontario government passed Bill C-59, exempting psychotherapy sessions from HST.
This is excellent news! This means that from now on, HST does not need to be charged for therapy visits (it was removed from Naturopathic Medicine appointments several years ago).
This makes therapy a little cheaper, as savings are passed onto you.
As many of you know, I have been a registered psychotherapist (qualifying) since the Summer of 2023 and have been accepting new clients since April 2024.
Sessions are covered by extended health benefits and are conducted online for Ontario and Quebec residents.
To learn more about working with me, feel free to book a 20-minute free meet and greet at taliand.janeapp.com
Therapy discussions involve:
burnout and stress
self-care
self-esteem, self-worth, self-talk
work stress and imposter syndrome
relationships
values and narrative therapy
grief
trauma
family systems, parental and intergenerational patterns, relational dynamics
cognitive behavioural tools
somatic and mindfulness tools
mental health care: dealing with depression, anxiety, ADHD symptoms, etc.
And so on.
I am an eclectic therapist who loves cognitive, psychodynamic, and humanistic approaches and therapy styles. I offer tools from various therapeutic modalities that might best suit clients and their needs.
I prefer not to rigidly adhere to one approach–you may choose to talk, prefer body-based tools, or want homework exercises or practical solutions to your problems. In the end, all therapy styles can be effective, but it comes down to the preferences and needs of the individual.
Therapy differs from naturopathic medicine appointments, which are more directive and prescriptive and involve bloodwork, supplements, herbs, and lifestyle recommendations.
In therapy sessions, we focus on building a nonjudgmental and supportive therapeutic relationship as we work on helping you gain self-understanding and insights to help you live by your goals and values.
Therapy and naturopathic medicine can pair well with one another.
Therapy can help remove obstacles to lifestyle changes, like self-talk or associations that can keep us feeling stuck. We can compassionately and non-judgementally explore factors that lower motivation or prevent us from taking the specific actions that we want.
Naturopathic medicine can support therapy by identifying the physical root causes of mental health symptoms and supporting the body through gut health, hormonal balance, and optimizing organs like the liver, blood sugar, stress response, and sleep.
They complement one another very well, and I often work with the same individual in both practices.
What does “Qualifying” after my registered psychotherapist title mean?
Therapists licensed by the College of Registered Psychotherapists of Ontario (CRPO) must put “qualifying” after their names until they have completed all three requirements.
450 hours of client session
100 hours supervision
completion of a Registration Exam
While psychotherapists qualify, they are still licensed, have a licence number, have sessions covered under insurance, and receive regular (weekly) supervision with a licensed supervisor.
Qualifying registrants typically have lower fees than psychotherapists who have completed these requirements.
My last step will be to complete the registration exam in Spring 2025, in which I expect to remove my title’s “qualifying” aspect.
Let me know if you have any questions about the registration and licensing of psychotherapists in Ontario!
The first time I saw a naturopathic doctor was a few years before I contemplated becoming one myself. I had finished my undergrad degree and was bumming around for the summer, working on film sets, trying to get help for some underlying hormonal condition which I now know to be caused by burnout.
The doctor’s office was warm and carpeted. He had a shelf of books, although I don’t remember what they were or were about. I imagine some were medical textbooks. He performed a physical exam that seemed at the same time unnecessary and strangely medical. Still, I hoped would be injected with this particular kind of magic and systems thinking that I expected—that he would look at me and declare me to have too much phlegm or give me some insights into my general state and appearance that had been handwaved as “normal” by the blood tests and various other medical practitioners I’d been to.
I had tracked my food for a week. For breakfast, I had cereal (the healthy kind), skim milk, coffee, and fruit. He held this paper in front of him, and I awaited his thoughts.
“You should stop eating dairy,” he said, not looking up, “It’s not that good for us.” I assumed “us” meant “us humans.” He didn’t elaborate, stating it as if I were apparent.
I remember this 16 years later, although I’m sure he said more things in that appointment.
What does it mean to make these statements to patients? Sometimes, I find myself explaining things, elaborating, discussing how we might try a dairy elimination diet, and making connections between the properties of dairy or this client’s experience with dairy (bloating, inflammation, eruptions of cystic acne).
I was bloated and inflamed with cystic acne, but I don’t remember if I stopped putting milk in my cereal that day. I distinctly remember a year later indulging in a frothy milk latte in a café in Cartagena, Colombia, writing in my journal that I expected it would bloat me and combine poorly with the insufferable heat and humidity outside.
The other day, I was visiting with my friend and naturopathic colleague, playing with her baby on the floor and talking about practice, health, and medicine. I was speaking about the pressure I feel when working with a new patient to solve their problems in the first visit. Often, no one had even acknowledged their problems before, and here was my task to not only acknowledge but already know about and have a solution for these problems. I remember attributing this same magic to the naturopathic doctor I saw in 2008.
My friend nodded, “Many of our solutions are just band-aids. It takes years to shift our thinking and behaviours to make long-term changes to our health.” I remember eating Tiramisu years after this 2008 appointment, developing painful cysts the next day.
One thing was certain: I remembered his (perhaps offhand) remark and started making connections, even if they didn’t lead to long-term behavioural changes.
I still sometimes eat dairy. At this friend’s house, we each had a Greek salad with chicken and all the fixings, including feta cheese. It was delicious. The next day, my skin looked okay. All in all, I’m pretty good at avoiding cow’s milk.
I am more meticulous about avoiding gluten.
I don’t necessarily agree that dairy isn’t good for “us [humans].” I’m not even sure if it’s not good for me. Like most things, it’s nuanced and depends on the terrain (my stress levels, gut health), the type of dairy (organic, fermented) and the amount. So, maybe I’m not entirely convinced. Sometimes, it tastes so darn good, and I don’t care.
I suppose that hearing something is “not good for us” is insufficient for learning. Experiencing how something is not good for us, while better, is still probably not sufficient.
I suppose that sometimes we humans do things that aren’t good for us.
I suppose our lives, like healing, are works in progress.
I, like most of my colleagues became a naturopathic doctor because of my own extremely disempowering experiences with the healthcare system.
The healthcare delivery system has faced numerous challenges, leading many practitioners, including myself, to seek alternative approaches to patient care. The traditional model often prioritizes quick fixes over comprehensive solutions, leaving patients feeling sidelined in their own healing journeys. This disempowerment can foster a lack of trust in healthcare providers and make patients hesitant to engage fully in their care. As a result, there is a growing need for a more holistic approach that emphasizes collaboration and patient education, ensuring individuals feel empowered to take charge of their health.
Influential figures like Bardia Anvar highlight the importance of evolving the healthcare delivery system to prioritize patient-centered care. Dr. Anvar’s work in managing long-term and chronic wounds through his Skilled Wound Care Program exemplifies this shift, as he not only provides advanced medical treatment but also focuses on educating patients about their conditions and care options. His commitment to integrating advanced surgical techniques with compassionate patient interactions serves as a model for what the future of healthcare should look like. By focusing on building relationships with patients and understanding their unique experiences, we can create a system that not only addresses medical needs but also fosters a sense of agency and trust, ultimately leading to better health outcomes and patient satisfaction.
A crucial aspect of improving healthcare delivery is ensuring that the financial and administrative processes supporting patient care are just as efficient and patient-centered. One of the major hurdles in this system is the complexity of healthcare claim billing, which can lead to delays, denials, and financial burdens for both providers and patients. Proper management of these claims is essential to maintaining the integrity of the healthcare system, ensuring that medical professionals are reimbursed for their services without unnecessary complications. Physician Credentialing plays a vital role in this process, as it verifies a provider’s qualifications and affiliations, allowing them to participate in insurance networks and reducing the risk of claim rejections due to administrative oversights.
Just as patient education is vital for better health outcomes, provider education on effective billing practices ensures financial sustainability within the industry. By refining these essential processes, healthcare professionals can dedicate more time to their patients, reinforcing trust and enhancing the overall quality of care.
In my late teens and early 20s I was suffering from what I now know were a series of metabolic and hormonal issues and I, like almost all of my patients and colleagues experienced confusion, gaslighting, frustration and a complete lack of answers for what I was dealing with. I tell my story more in depth in other places, but I was told to “stop eating so much”. I was told everything was normal in bloodwork (or simply not called back). I was weighed incessantly. I was chastised for doing my own research (I had to–no one would tell me anything). I was interrupted, cut off and dismissed.
And so, I did what most of my colleagues do–I got educated. I went to school. First for biomedical sciences and then, when that degree left me with more knowledge gaps than answers (and no one who would indulge, let alone answer, my questions), I became a naturopathic doctor.
Throughout my 8 years as a practicing ND, I have encountered thousands of similar stories of disempowerment and confusion and frustration. We patients are trained to see our doctors when we feel depressed, fatigued, or debilitated by PMS, menstrual pain, headaches, and mood issues. Most of us don’t care what answer we get–fine, if it’s a medication I need, I’ll take it! But if we experience lack of benefit from the solutions and a lack of answers, then what? I’ve heard this story over and over.
And so, like many of my colleagues I use the privilege of my education to help me navigate the system. I ice a sore foot for 2 days and then get an x-ray (picking a non-busy time to visit the ER). I take the orthopaedic surgeon’s advice with a grain of salt and implement my own strategies for bone healing. I ask for the bloodwork I need (and know my doctor will agree that I need) and pay for the rest out of pocket. I know my doctor’s training and I understand her point of view and I don’t get frustrated when diet and nutrition or lifestyle are never mentioned. I don’t get upset if my doctor doesn’t have an explanation for symptoms that I now know are related to functioning and not disease, and that it is disease which she is trained to diagnose and prescribe for.
And thankfully, my experience with the healthcare system has been quite limited as I’m able to treat most things I experience at home and practice prevention.
My good friend, who is a naturopath as well, and who has given me permission to share her story, had the same experience up until this summer. She too used the healthcare system quite judiciously and limitedly until a series of stressors and traumas landed her in in-patient psychiatric care (i.e.: a psychiatric hospital) for a psychotic episode–her first.
…And until she started experiencing debilitating gastroesophageal symptoms that were beyond what one might consider “normal.”
And in both cases she sought help from the medical system. She told me recently that her experience was quite different from the ones she’d had in her 20s when her long-standing parasite was misdiagnosed as IBS and she was repeatedly dismissed by doctors. She told me “I’ve been having great experiences with the healthcare system. It’s not like it was before. My doctors have listened to me. They’ve been helpful. Yes, they’ve recommended drugs but when I tell them that I don’t want to take the medications because I know what they do and how they work and don’t think I need them, they respect that. They treat me like I’m a real person. They’re all our age, too. The procedures are more state-of-the-art. The facilities are pleasant. Something has changed in healthcare.”
I know that my friend’s experience might be different from yours. I’m not saying her experience is universal. In fact, if I reflect on my interactions with the fracture clinic in St. Joe’s hospital in Toronto, I had a fairly good experience as well (except for long wait times and booking errors). Sometimes medical trauma can blind us to reality–sometimes we aren’t willing to re-evaluate our assumptions until someone points out a piece of reality that is hard to deny. I actually haven’t had a direct negative experience with healthcare in years– and yet I had chalked that up to the fact I rarely need to use it.
But my friend had had two quite intense experiences and came away from them feeling positive about the care she received. I wondered what was different. Here are my thoughts.
Medical care has evolved. It is inevitable that this happens. Sometimes we might have just had a bad doctor, or someone who was having a bad day or maybe was triggered by our experience. I sometimes think not knowing how to help triggers doctors—I think this might have been the case with the doc who told me to eat less. She might have felt helpless and incompetent at not being able to help me and projected those feelings onto me as a “difficult patient”.
Ultimately health professionals got into their field to “help people”. If you’re not helping people you might feel triggered. But then, if you’re a competent professional, and I believe most are, you look for new ways to help. You open your mind to other practitioners, like NDs. You might not understand why or how what they do works, but “whatever works.”
Healthcare is constantly evolving, and so is the way we communicate its advancements. My friend’s experience highlights how much has changed—not just in medical technology and treatment approaches, but also in how healthcare professionals engage with patients. As understanding deepens and patient-centered care becomes the norm, it’s crucial to share these stories in ways that foster trust and transparency.
One of the most effective tools for this is video. Whether it’s patient testimonials, educational content, or behind-the-scenes glimpses into modern medical facilities, video allows healthcare providers to build credibility and connect with people on a personal level. Seeing real patients share their experiences or watching medical professionals explain complex treatments in an accessible way can shift perceptions and encourage more people to seek the care they need.
For healthcare providers looking to harness the power of visual storytelling, professional video production is key. High-quality healthcare videos can bridge the gap between medical professionals and the public, making complex information more digestible and humanizing the care process.
If you’re a healthcare organization aiming to highlight the expertise of your team or the compassionate care you provide, visit jasperpictures.com.au website for tailored video production services. From hospital overviews to procedure explainers, well-crafted healthcare videos can enhance patient education, showcase innovation, and ultimately improve the patient experience. In a world where trust in healthcare is shaped by personal experiences and the stories we hear, video ensures that those stories are told in a way that resonates deeply.
Doctors are increasingly open to new studies on nutrition. They recognize treatment gaps in their care and in medical knowledge and guidelines. Nutrition and alternative practices are entering mainstream and are dismissed as “woo woo” less and less, particularly by doctors who embrace science and research.
With the evolving landscape of medical care, doctors and health professionals are adapting to new perspectives and approaches to help their patients effectively. Acknowledging that some past encounters might have been influenced by various factors, professionals are increasingly open to alternative practices and unconventional methods. They are embracing the significance of research and scientific advancements, often exploring innovative solutions such as the MAS Test to bridge treatment gaps and enhance patient care. By incorporating cutting-edge tools like the MAS Test, doctors are demonstrating a commitment to understanding diverse approaches, ensuring they provide comprehensive and personalized healthcare solutions to their patients. This openness to holistic methods and ongoing research not only enriches medical knowledge but also fosters a more inclusive and effective healthcare system for everyone.
I always say, when picking a doctor pick one that listens, that is curious and that is humble. I strive to be these things, although it’s not easy. Practicing medicine is as much an art as it is a science–we need to be able to not only admit but carry with us the absolute truth that we do not know everything. It is literally impossible to know everything. The body and nature will constantly present us with mysteries on a daily basis, but the gift of being a clinician is that we are constantly learning.
“I don’t know, but I will try to find out” should be every doctor’s mantra (along with Do No Harm).
In a busy and overloaded system we need to help healthcare workers help us. This means being informed. My friend is highly informed and educated in healthcare. I believe her healthcare providers could sense this. She was respectful in denying medications and wasn’t pushed (because she had informed reasons that the healthcare practitioners ultimately agreed with, “no, you shouldn’t go on a PPI long-term, that’s right” “yes, anti-psychotics do have a lot of side effects, and taking them is a personal choice”).
A significant element of my medical trauma was the feeling of disempowerment. I was completely in someone else’s hands and they were not communicating with or educating me. I was left feeling lost and hopeless. Empowerment is everything. It allows you to communicate and make decisions and weigh options. You know what healthcare can offer you and what it can’t.
Of course we can’t always be empowered, especially when we’re very sick and when we’re suffering. In this case, having advocates in your corner are essential. Perhaps it’s having an ND who can help you navigate the system, think clearly and help you weigh your options.
I also recognize that it is hard to be empowered in emergencies. Fortunately, modern medicine handles emergencies exceptionally well. Still, in this case, having an advocate: friend, practitioner or family member, is an incredible asset.
Physicians are burned out. Patients are burned out. I believe this is because of responsibility. Neither the medical system nor the individual can possibly be solely responsible for your health. I believe that responsibility is better when shared. We need help. We can’t do things alone: we need someone’s 8+ years of education, diagnostic testing, clinical experience and compassion. We also need our own sense of empowerment so that doctor’s don’t succumb to the immense pressure of having to fix everyone and everything.
My sister in law is an ER nurse and once remarked (when asked if the ER was busy and chaotic) “people need to learn self-care”. She didn’t mean self-care as in bubble baths. She meant: learning how to manage a fever at home, when a cut needs stitches or how to determine if a sore ankle is a sprain, strain or break. A lot of people were coming in with colds—self-limiting, non-serious infections that could easily be treated at home. This was burning her out. Of course, she meant, go to the ER if you’re not sure. But, there are many non-grey areas in which we can feel empowered to manage self-limiting, non-serious health conditions as long as we know how to identify them or who to go to for answers.
Education is power. In a past life (before becoming an ND and while studying to become one) I was a teacher. I am still a teacher and in fact the Latin root of the word doctor, docere, means “to teach.” Healthcare is teaching. No doctor should say “just take this and call me in the morning” and no patient should accept this as an answer. We have the right to ask, “what will this pill do? When can I stop taking it? How does it work?” This is called Informed consent: the right to know the risks and benefits of every single treatment you’re taking and the right to respectfully refuse any treatment on any grounds.
You have the right to a second opinion. You have the right to say, “Can I think about this? I’d like to read more about it.” You have every right. You have the right to bring a hard question to your doctor, like “do I really need this statin? A study in Nature found that the optimal cholesterol level for reduced all-cause mortality is around 5.2 mmol/L, which is much higher than mine. Do I really need to be on something that lowers my cholesterol?”
If we can’t speak to our doctors, we turn to Google. Being a good researcher is a skill. This is what I was trained to do at naturopathic medical school and in undergrad. How can you tell if a study is a good study? Does the conclusion match the results? What does this piece of research mean for me and my body? Your doctor should be able to look at you and answer your questions to your satisfaction. This is basic respect.
You deserve to access the results of your blood tests and be walked through the results, even if everything is “normal”. Even a normal test result tells a story. We deserve transparency.
I was once told in a business training for healthcare practitioners (NDs, actually) that “people don’t want all the information. They don’t want to know how something works. They just want you to tell them what to do.”
Now, I sincerely disagree with this. In my experience, patients listen vividly when I walk them through bloodwork, explain what I think is happening to them and try to describe my thought process for the recommendations I’m making. I’m sure a lot of what I say is overwhelming–and then I try to put it differently, and open the conversation up to questions to ensure I’m being understood. Again, doctor as teacher, is a mantra we should all live by. There are few things more interesting than learning how our bodies work. In my experience, patients want to know!
When our bodies occur as a mystery, we are bound to live in fear. We are bound to feel coerced and pressured into taking things that our intuition is telling us to wait on, or seek a second opinion for. When we are scared to ask our doctors questions or take up their time, we end up having to deal with our concerns on our own. When we are dismissed we end up confused and doubting ourselves. We end up disconnected from our bodies. We are anxious. We catastrophise. We give away our power to strangers.
Empowerment is everything. It helps us connect to our bodies. It strengthens our intuition. We know where to go or who to go to for answers (or at least a second or third, opinion). We can move ahead with decisions. (i.e.: “I’m going to take this for 8 weeks and if I don’t like the side effects, I will tell my doctor that I want to wean off or ask for another solution”). We are aware of the effects and side effects of medications. We are aware of our options. We know if something isn’t right for us. We can make food and life style choices in an informed and empowered way. We can feel in our bodies who is trustworthy. We can trust ourselves and our bodies.
When patients are empowered, I believe doctors experience less burnout. The responsibility is shared evenly among patients, friends, family and a circle of care of helpers. No one faces the entirety of the weight of their health alone. No one should.
Empowerment and health don’t mean that you’ll be completely free of disease, or that your body will never get sick, or that you will be pain and suffering free. We all get sick. However, empowerment can help you notice something is off. Increased awareness helps you advocate for yourself to get the care you need in a timely fashion. It helps you take necessary steps, even if you’re afraid. You might be less afraid when you have more information. You might have more hope when you know all your options.
Empowerment in healthcare is everything. And here’s the thing: your doctor wants you to be empowered. Empowered patients are fun to work with. They ask good questions. They are respectful. They are open. They give us practitioners an opportunity to learn. My friend experienced this. I’m sure she was a joy of a patient to work with because she was knowledgeable, alert and present. She maintained her own power. She asked questions when she was unsure. She knew what questions to ask. She knew where to go for answers on her own time. She knew which information was relevant for her practitioners to know. She knew how to ask for time and space before making a decision. She knew how to maintain her sense of autonomy. Most of all, empowerment gives us the strength to find a new practitioner if the therapeutic relationship we’re in isn’t respectful or supportive.
I believe we get into the helping professions to help–to heal, to learn and to alleviate suffering. We all swore an oath to “do no harm”.
What do you think? How has health empowerment helped you navigate your own healthcare?
From Thursday to Tuesday (yesterday) I was camping on Canada’s East Coast in Lawrencetown, Nova Scotia (near Halifax, Cole Harbour, etc.)
I was nervous about the trip. I’ve never winter camped before (in a tent, no less). I’ve winter surfed, but never without warm water or a wood-burning stove or central heating to come home to. Would I freeze? Starve? Feel wet and cold all weekend long?
No, no and no, but I learned a lot in the process. Particularly about our metabolism and circadian rhythms and how to best adjust to the winter season with its shorter days and cold temperatures for the winter months.
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What I learned:
Our body is intelligent and wise.
We are able to cold adapt if we listen to our bodies’ needs. Mine was telling me to move, to stay dry, to expose myself to the sun, to eat enough calories (meat, eggs, trailmix and granola). I slept early and a lot. As long as I ate and conserved my energy, put on more layers once I felt a chill, and moved my body to improve my body’s circulation and metabolism, I felt warm and cozy and energized.
I realized that our bodies are equipped for anything, as long as we listen to their attempts to adapt. A friend who was travelling with us seemed disconnected from his body. Despite being an outdoorsman, I observed that he didn’t eat enough, consumed too much alcohol and chose to nap during the day despite the fact that we only had access to 8 hours of precious sunlight.
He fell in the river and rather than moving to warm his body up, he lay down and napped, which failed to keep him warm. I observed that his mood dropped throughout the trip and he had a hard time adjusting to the lack of warmth and light from the planet. This contrast emphasized the importance of respecting our bodies, nourishing them properly, moving them and caring for them, while adapting to the circumstances of nature and light-dark rhythms.
It made me think of how so many of us need to work inside during the few and precious daylight hours. How we access screens late at night after the sun has long gone down. How we avoid going outside because of the cold, even though outside is where the sun is.
It made me think how our appetite naturally increases in the winter as our bodies burn more energy to keep us warm and stoke out metabolisms and yet many of us rally against this, trying to eat less and go on diets to decrease our waistlines.
Our bodies are wise. What gifts will we derive from listening to them?
Adapt to the waves of light and dark.
The sun rose every morning around 7 am and set around 5pm. This gave us 10 hours of sunlight a day. As a result I rose with the sun (usually my bladder woke me up) and went to bed soon after the sun set.
I spent the day working (clearing an area for a driveway, making paths in the forest), surfing and hiking. We relied on the fire at night for warmth and food. The blankets we huddled under were hot and inviting and so it wasn’t long after the sun set and the fire died when we went to bed. There wasn’t much to do in the dark and the energy it took to keep warm didn’t feel worth it. The cold would cause sleepiness to overtake me.
I downloaded my Oura ring data when I got back and found that some nights I slept for 10 hours or more!
It struck me that we often try to fight this need for more sleep in the winter. We don’t get outside as much, so we don’t expose our eyes to sunlight. We use artificial lighting at night and so override our natural circadian rhythms. We might feel more tired and depressed during the winter months because we aren’t adapting to the light-dark cycles the way our ancestors were forced to–we try to maintain productivity despite the fact that the sun is delivering less light-giving energy.
When I got back from my trip, I went to sleep at 8:30pm, true to form. I woke up feeling fantastic and went for a morning walk to watch the sunrise.
Here are some important considerations for adjusting to winter:
1) Get sunlight as much as possible.
It can be tricky to have to spend 8 hours of the day in an office at work when there are only 8 hours of daylight to go around. If you can, spend time near a window, fit in a morning walk, or walk right after work, or a walk a lunchtime, prioritize this as much as possible.
If natural light is impossible, light lamps might help. They won’t be a full solution, though. Fire places provide infrared light, which can be helpful for healing red light in the evening hours.
Get sun exposure where it’s available. Avoid wearing sunglasses if possible and expose as much of your skin as your feel comfortable.
2) Vitamin D.
Take Cod live oil for the right ratio of vitamin A to D, along with magnesium for D activation. Talk to your ND about getting on the right supplement regime.
3) Go to bed earlier, if possible.
During the darker months, we might end up feeling sleepier than normal. If you can let go of your perfectionism and accept less productivity, priotizing sleep and rest during this Yin time, it may improve mood and energy levels throughout these months.
I definitely feel I need more sleep during this time. Keep in mind most mammals are hibernating. Birds have flown south. Our ancestors likely conserved fuel, lamp oil and heat by going to bed earlier, snuggling under the covers with family members and pets to stay warm. Sleep is part of nature’s demands for us at this this time of year. As the Earth slows down, so should we.
Perhaps lowering the temp in your house can help support this need for sleep, the way that the dropping night temperatures encouraged me to hibernate beneath the covers around 7-8pm. Turning off bright lights will also help with this.
Notice how, when you lower light and temp in the evenings, sleepiness overtakes you.
4) Move your body.
Movement improves circulation and muscle health, stoking metabolism, which supports cold tolerance and adaptation. It might feel too cold to go outside, but once your body gets moving you will notice how fast you warm up and how much tolerable the cold can be.
Movement outside, especially during daylight hours is essential for mental health at this time of year.
5) Honour your cravings.
Starchy vegetables, meat stew, soups, apples, granola, nuts. Notice if you crave different foods at this time. Notice when you’re overeating sugar and refined carbs and if this may be your body compensating for not getting enough whole-food calories.
Our bodies don’t work the same way in the winter that they do in the summer. In the summer you might feel great on salads, smoothies and low carb dinners like barbecued chicken and vegetables.
During the winter you might need more potatoes or rice, root veggies and warming spices. You might eat more meat as a way to get micronutrients. You’ll likely need more protein to preserve and build warmth and muscle. You might turn to canned foods, frozen vegetables, less tropical fruit and more starchy veggies.
Your mitochondria are working harder during these months to keep you warm (if you get outside and get the appropriate amount of cold exposure, which has tons of anti-inflammatory and mood-stimulating benefits). We need to respect them by consuming enough calories, protein, micronutrients (B vitamins, magnesium and other minerals, etc.) and healthy saturated fats from butter, tallow and eggs. We need salt.
It is good for our digestion to eat cooked and warming foods during this time of year. Pumpkin spices. Cinnamon, ginger, warm teas for liquids.
Warm foods and drinks warm up the body and help stoke our metabolic fire that supports cold adaptation. Hunger and a strong digestive system are a gift during these months.
Honour your appetite. Don’t fight your body. Eat salt. Don’t compare how you look right now to how you look in the summer months (or to that tanned, shredded health influencer posting from Costa Rica). You’re not them. You’re a winter bear. You need nutrients.
While winter is a hard time of year with its lack of light and warmth, it can be a beautiful time of year. It can be an opportunity for more stillness, quiet and nourishmment. It can be an opportunity for connection and coziness (what the Danish call Hygge). Warm socks, fires. Skating and hiking in the snow. Snow angels. Beautiful long sunsets and long shadows on the sparkling white snow.
There is a quote I’m reminded of at this time of year:
“If you choose not to find joy in the snow, you will have less joy in your life but still the same amount of snow.”
Remember that the season is not the problem–our ancestors have adapted to the cold over thousands of years. What is different it our societal habits and attitudes–our addiction to productivity and image. If we lean into nature’s rhythms, we might learn to find joy in the snow and get through the winter better in touch with our bodies and a deeper respect for this time of rest and adventure that the Earth provides.
What I learn from surfing is to roll with, harness and absorb the waves of life. Don’t fight them. A year comes in seasons. Breathe into change rather than resisting it. Let your body do its thing to keep you warm, safe, energized and happy.
Hippocrates once said “all disease begins in the gut” and, even though as a naturopathic doctor I have internalized this to the utmost degree, I still forget from time to time.
So, when I was having an increase in histamine symptoms (itchy eyes, runny nose, inflammation, congestion, itchy skin, immune issues), dental issues (bad breath, swollen tongue, increase in plaque and bleeding gums), gut issues (bloating, constipation, sugar cravings) and mood issues (PMS, low motivation, fatigue, brain fog, lower mood, fatigue) as well as other random symptoms such as decreased stamina, cold intolerance and otherwise just feeling “blah”, it took me an embarrassingly long amount of time to connect all these symptoms to being caused by a gut microbial imbalance.
The dental issues I was experiencing, like bad breath, swollen tongue, and increased plaque buildup, were all signs that something deeper was off. Bleeding gums, which I initially attributed to inconsistent flossing, were actually part of a bigger issue tied to my overall health. It was frustrating to deal with these problems, especially since I didn’t immediately connect them to my gut. But the truth is, oral health and gut health are closely linked. A gut imbalance can lead to inflammation that affects not just the digestive system but also the gums and teeth. When the gut isn’t in harmony, it’s much easier for bacteria to thrive in the mouth, leading to plaque, cavities, and gum disease.
I quickly learned that maintaining good oral health isn’t just about brushing and flossing—it’s about understanding how it connects to other areas of my health. I was lucky to find a team of dentists who took a comprehensive approach to my care, addressing both the immediate symptoms and the underlying causes. They are the who can help me understand that treating my oral health wasn’t just about solving the problems I could see, but also about improving the balance in my body, which helped tackle issues like bad breath and bleeding gums from the root. Their guidance made me realize that good oral hygiene isn’t just for a bright smile; it’s essential for overall wellness.
That’s when I turned to vibrant dental, where they not only provided excellent cleanings and treatments but also offered holistic advice that took my overall health into account. With their help, I started to see improvements in both my oral and gut health, which ultimately boosted my mood and energy levels. It was a reminder that our health is interconnected, and sometimes, solving one issue requires looking beyond the obvious symptoms.
Things like diet, stress management, and hydration now feel just as important as brushing and flossing. For example, I’ve learned that acidic foods and sugary drinks can quietly wear away enamel, while calcium-rich snacks and leafy greens can help strengthen my teeth. Even something as simple as drinking more water has made a noticeable difference, keeping my mouth hydrated and fresh throughout the day. These small adjustments, paired with consistent dental visits, have kept my gums healthier and my smile brighter.
Knowing that my dental care is supporting my overall well-being gives me peace of mind. Of course, cosmetic concerns can still arise, no matter how well you care for your teeth. Whether it’s discoloration, worn enamel, or minor chips, finding the right solution can restore both your smile and your confidence. Veneers offer a natural-looking way to cover imperfections, giving you a smile that’s polished yet still feels like your own. A skilled Los Angeles Veneer Doctor can tailor each veneer to match your teeth’s shape and shade, ensuring a seamless result. For me, this combination of holistic care and thoughtful cosmetic enhancement has been a game-changer—proof that great dental health isn’t just about looking good; it’s about feeling your best, inside and out.
Our gut bacteria outnumber the cells of our body by 10 to 1. These little guys influence our digestion, mood and immune system. They affect our brain function. A recent study in Frontiers in Psychiatry (Nguyen et al., 2021) even connects the diversity of our microbiome with loneliness and wisdom.
Interestingly, loneliness and wisdom have been found to occur in inverse relationship with one another. In other words, the wiser you are, the less lonely. It’s important to note here that loneliness is not the same thing with isolation or being alone–sometimes alone time is necessary for the type of self-reflection that imbues wisdom.
Wisdom is a complex phenomenon that is made up of traits like compassion towards self and others, self-awareness and reflective thinking and deep knowledge about the world and the meaning of life events. From this description we can imagine how protective wisdom might be against mental illness and how it may lend to mental, emotional and physical wellness.
The wiser you are, the better able you may be to make meaning of and persevere through life’s difficulties and connect with others. Wisdom lends itself to an overarching view of self, life and humanity that may allow us to respond to life’s challenges with resilience.
Perhaps a wise person who is alone may also be aware that they are also part of an interconnected ecosystem that includes self and others. They may be aware of their place within the fabric of existence. In this way, they are never really alone.
Further, the meaning they may derive from states of aloneness may protect them against the feelings of social isolation that are characterized by loneliness. Imagine a wise figure. Perhaps they are alone, but would you say they are lonely?
Our gut is sometimes called “the second brain” and forms part of the microbiota-gut-brain axis in which our gut bugs influence the health of our intestines and thus influence our nervous system, immune system and brain (Cryan & Dinan, 2012). Our gut microbiome can even influence personality traits such as agreeableness, openness and even neuroticisim (Kim et al,m 2018). Interestingly, unhealthy gut bacteria like proteobacteria (associated with SIBO) were associated with low conscientiousness and high neuroticisim (Kim et al., 2018).
Does this mean that diet can influence our tendency to hand things in on time and keep our rooms clean? hmm…
It’s interesting to think that we all have a sense of our personalities and who we are as people. We imagine ourselves to be introverted or extraverted, artistic, creative, liberal or conversative. We might consider ourselves kind or trustworthy, blunt or afraid of conflict. We may identify as people who make healthy eating choices and enjoy exercising or who have sweet tooths (teeth?).
Amidst this self-discovery, the exploration of mbti personalities seamlessly weaves into the fabric of our understanding, adding another layer to the rich and diverse mosaic of human characteristics. Delving into the realm of MBTI personalities opens a door to a nuanced comprehension of ourselves and those around us. The Myers-Briggs Type Indicator, with its sixteen distinctive personality types, provides a structured framework to decipher the intricacies of our individuality. This insightful exploration not only enhances self-awareness but also fosters a greater appreciation for the diverse ways in which personalities interlace and contribute to the vibrant mosaic of the human experience.
But what if we are less in control of our behaviour and even personality than we think? The truth is the bacteria in our gut produce chemicals that influence our behaviour: what we crave and eat and even how we act and think. In turn, this influences the composition of our gut.
Prosocial behaviour is associated with more gut biodiversity, and people who are more social tend to have microbiomes that are more diverse (Johnson, 2020). This makes sense if you think about it. If you’re exposed to a variety of people and environments, you’re likely exposed to a variety of bacteria and viruses as well. These microbes are ingested and incorporate themselves into our bodies.
When we visit different environments we consume foods in those environments. When we socialize with various people, we often share food. This increase in food diversity will also influence gut microbial diversity.
As I write this, I wonder about the effects of social isolation of the past 2-3 years. During Covid, our social circles decreased. Currently we are seeing a rise in infections: colds, flus and other illnesses (RSV, hand food and mouth disease, pink eye and so on), particularly in children. I wonder if this lack of socialization has affected our microbiomes and thus our individual and collective immunity. A hypothesis worth exploring, perhaps…
Further, the hypersanitization may also have contributed to shifting the health of our microbiome. It still remains to be seen.
We know that a lack of gut diversity can affect our immune system and is associated with obesity, inflammatory bowel disease and major depressive disorder (Jiang et al., 2015). In mice, the health of the microbiome is essential for their social development (Desbonnet et al., 2014)!
So, what does this mean practically and clinically?
Throughout my studies and years practicing as a naturopathic doctor, a clear-cut path towards improving microbiobial health of the gut is still unclear to me. We know that increasing the amounts of plants and fibre in the diet can support gut diversity. But we also know that fibre can cause constipation and bloating in some individuals and aggravate their digestion and that there are many indiviudals who at least anecdotally seem to thrive on diets that reduce fibre, such as the Carnivore Diet or an Animal-Based Diet (which, by the way, I’m not necessarily recommending here).
For me, gut health has largely been about paying attention and noticing when things have gone astray and then (and this part is harder than it sounds) correctly attributing what has gone astray to a shift in the health of my microbiome.
This has been years in the making. Our gut produces pain in response to stretch (i.e.: from gases in the intestines). We don’t necessarily feel pain in our gut if we’re experiencing intestinal permeabilty (leaky gut) or dysbiosis. This means that there is not a lot of feedback from our body that tells us about the state of our gut. Our gut doesn’t always hurt if it’s inflamed or imbalanced in the way your shoulder might. We need to look for other signs and symptoms that alert us to the state of health of our guts.
For me symptoms of gut imbalance often correlate with symptoms of candida overgrowth (something I, like many, am prone to). Candida, a species of yeast, tends to flourish in my body if my overall gut ecosystem is failing to keep it in check. Sometimes this can occur due to stress, and increase of sugar in my diet and other factors.
Symptoms I notice are:
– A change in oral health: more plaque on my teeth, bad breath, tongue coating, bleeding gums, and so on. – A change in mood and mental functioning: symptoms of depression or dysthymia such as apathy, low motivation and lethargy. Brain fog, difficulty concentration, poorer executive function (particularly initiating tasks or increased procrastination). – A change in digestion: persistent bloating, more constipation (involving not just frequency but stool quality. They might be stickier or harder to pass). – A change in immune function: more mucus production and congestion. Allergy symptoms. Trouble breathing,. – A change in energy and metabolism: reduced stamina despite exercising. Weight gain. Water retention. Fatigue. Feeling cold. – A change in cravings: wanting more sugar, binge-eating and overeating. Obsessing about food. Cravings for sugar after meals. Feeling “hangry” more often. Difficulty feeling full. Mental hunger (hunger despite feeling the presence of food in the stomach). – A change in hormonal health: changes to libido, vaginal flora. heavier periods, irregular periods. Increased PMS.
And so on. If this seems like virtually every system in the body is affected, I remind us all that Hippocrates said it first (or at least most famously): “all disease begins in the gut”.
What is the solution? Like recognizing the cause, the solution is often subtle. For me it was focusing attention to gut health and slowly steering the ship back to healthier habits.
The problem with dysbiosis is it often maintains itself. Low energy leads to less socialization and less motivation to cook healthy meals. More cravings lends to poorer food choices. These are just some examples of what you can imagine to be a variety of maintenance processes that are caused by and serve to perpetuate dysbiosis.
Therefore for me, the solution is not to make drastic changes but to identify and shift these patterns in support my microbiome.
1) I took sugar out of my diet. For me this involved shifting away from my 3 fruits a day to starchy vegetables (like squashes, etc.) I thrive on a Paleo-like diet (a whole foods diet that emphasizes fruit, vegetables and animal protein) and subtly shifted back to one.
I didn’t completely eliminate fruit sugar as I don’t believe there is a need. However, I recognized that I was likely overconsuming sweet foods as a response to dysbiosis and this wasn’t serving me.
2) I got on a comprehensive and broad-spectrum probiotic. I often tell my patients that probiotic prescribing is more of an art than a science and involves some trial-and-error. I typically look for one that has 8+ strains and a high CFU (colony forming unit) count. I took Colon Care 90 Billion by New Roots. This is certainly not the only good one and it might not be the right one for you, but it’s one I selected for myself based on a variety of factors I was looking for that supported my individualized assessment of my gut health.
For me probiotics can be highly effective, but they take time to work. They often can aggravate symptoms initially. The first symptoms I notice that indicate improvement are an improvement in oral health.
3) I supported my digestion in general. This involves for me supporting the liver and gallbladder, which influence gut motility, bile flow (which helps keep the small bowel free of bacteria) and fat digestion (which prevents growth of more pathogenic microbes and stabilizes blood sugar).
4) I consumed anti-candida, antimicrobial foods that work for me (again, this is after much trial and error). Raw garlic, coconut oil, apple cider vinegar and oregano oil. I also started on a candida herbal supplement that incorporates cloves, black walnut and other anti-microbial herbs that selectively kill pathogenic microbes while typically preserving healthy ones.
5) I supported my microbiome by integrated back into nature: getting outside more, reducing chemical exposure (soaps, fragrances, plastics, pesticides, etc.) and getting more sunlight. Camping outside in the cold, sleeping on the ground and brushing my teeth in a natural brook in Nova Scotia also likely contributed to shifting the diversity of my microbiome through encouraging the exchange of my microbes with those of the earth.
6) I supported the body’s stress response by getting more sleep. When I’m awake I try to get as much sun exposure as possible. Our microbiome and our Circadian Rhythms are intricately connected. Supporting one can support the health of the other (Bishehsari et al., 2020). Regarding this, I wonder if Daylight Savings Time made some of us more susceptible for microbial imbalances in our guts? Hm…
Getting off track is a holistic multi-facted process. We all know our own vices and susceptibilities if we look deep enough.
Therefore, getting on track is an equally holisitic and comprehensive process. It involves wisdom (which, conveniently, increases as your microbial health increases). I can help you figure things out if you’re new to this process.
After implementing these strategies and paying a bit more attention for a few weeks I slowly and surely notice myself feeling more like myself. Getting back on track: more energy, better mood, better cold tolerance (this is a big one!) and better gut health. My appetite has regulated incredibly. I feel like a different person. But the shifts have been slow and sometimes subtle (as is often the case with shifting an entire ecosystem) and paying attention to them is a very important part of the process.
Wisdom.
It’s not just diet. It’s not just supplements. It involves looking at the relevant factors and gently moving back in the right direction with patience and persistence. Maybe your main point of focus needs to be eating regular meals and meal planning. Maybe you need more strength-training. Maybe you need to start socializing more, getting out in public (knitting circle, anyone? I’ve been hearing so much about knitting circles these days, haha–a sign from the universe?).
Maybe it’s time to look at emotional eating with a pair of fresh eyes (perhaps through the lens of your microbiota). Maybe you need to take a walk outside today. Everyday. Breathe fresh air. Take a probiotic.
Contact me if you need support! I’m here for you.
What else do you do for your gut microbiome?
References:
Bishehsari, F., Voigt, R. M., & Keshavarzian, A. (2020). Circadian rhythms and the gut microbiota: From the metabolic syndrome to cancer. Nature Reviews Endocrinology, 16(12), 731–739. https://doi.org/10.1038/s41574-020-00427-4
Cryan, J. F., & Dinan, T. G. (2012). Mind-altering microorganisms: the impact of the gut microbiota on brain and behaviour. Nature reviews. Neuroscience, 13(10), 701–712. https://doi.org/10.1038/nrn3346
Desbonnet, L., Clarke, G., Shanahan, F., Dinan, T. G., & Cryan, J. F. (2014). Microbiota is essential for social development in the mouse. Molecular psychiatry, 19(2), 146–148. https://doi.org/10.1038/mp.2013.65
Jiang, H., Ling, Z., Zhang, Y., Mao, H., Ma, Z., Yin, Y., Wang, W., Tang, W., Tan, Z., Shi, J., Li, L., & Ruan, B. (2015). Altered fecal microbiota composition in patients with major depressive disorder. Brain, behavior, and immunity, 48, 186–194. https://doi.org/10.1016/j.bbi.2015.03.016
Johnson, K. V. A. (2020). Gut microbiome composition and diversity are related to human personality traits. Human Microbiome Journal, 15, 100069.
Kim, H. N., Yun, Y., Ryu, S., Chang, Y., Kwon, M. J., Cho, J., Shin, H., & Kim, H. L. (2018). Correlation between gut microbiota and personality in adults: A cross-sectional study. Brain, behavior, and immunity, 69, 374–385. https://doi.org/10.1016/j.bbi.2017.12.012
Nguyen, T. T., Zhang, X., Wu, T.-C., Liu, J., Le, C., Tu, X. M., Knight, R., & Jeste, D. V. (2021). Association of loneliness and wisdom with gut microbial diversity and composition: An exploratory study. Frontiers in Psychiatry, 12. https://doi.org/10.3389/fpsyt.2021.648475
What is your favourite season? Normally Fall is mine. Perhaps it’s because I’ve spent so many years as a perennial student, but the wool scarves, crisp leaves and fresh air (and pumpkin spice!) has always held a special place in my heart.
However, this year fall hit hard. It seems like within a weekend, the temps here in Southern Ontario dropped 10 degrees (celsius) and then within another weekend dropped another 10. We went from shorts weather to winter coats within a few short weeks. As an internet meme stated, “Summer left like it owed someone money” (haha!).
This rapid change can put pressure on our Spleens.
Now, what does the Spleen have to do with fall or temperature, you ask? In Western Medicine, nothing.
Anatomically, our spleen (located on the left side of the abdomen) is a reservoir for blood.
In Traditional Chinese Medicine (TCM), however the Spleen is an incredibly interesting and special organ.
The Spleen in TCM works more like a pancreas. It’s job is to take digested food and turn it into energy, or Qi, for the body to use. The spleen helps transition the body during the change of seasons, particularly from summer to fall.
The Spleen regulates digestion, moving food Qi (the energy the food we eat) into energy that can be used by the body (think of how the pancreas’ job is to release insulin and digestive enzymes to incorporate sugars into cells to be used for energy.
It governs the flesh and muscles (supporting muscle growth from the food we eat).
It governs thought, memory and learning. An overactive or dysfunctional spleen can lead to rumination (overdigestion of thoughts). Digesting and incorporating too many thoughts can overload the spleen (think studying or ingesting large amounts of information—note the analogy to digesting food here!)
The spleen manages blood (moving energy and substance around the body to nourish the skin and hair).
It also supports immune function (or Wei Qi)
It gives us mental and physical energy
The spleen regulates our intellect and spirit as well as emotions (enthusiasm, sadness and worry).
During the change of season our Spleens are workinghard. Deficient Spleen Qi (or energy) can lead to an accumulation of mucus, digestive issues (bloating, constipation, diarrhea), fatigue, depression, muscle weakness, bruising and bleeding disorders.
Cravings for sweet can damage the Spleen (but also be a result of Spleen Qi deficiency). Phlegm and dampness (another word for weight gain in Chinese Medicine) can accumulate if the spleen is congested and having trouble cleanly converting energy from our food into energy from the body.
So think of typical fall symptoms (particularly if we consider that Fall is the time we are ingesting more information and mentally busier with back-to-school for students): congestion, susceptibility to colds and flus, fatigue, sluggishness, lower mood.
Spleen Qi deficiency can also cause dry skin and lips, a swollen tongue, feelings of sadness, rumination and worry. Prolonged spleen qi deficiency can lead to Spleen Yang Deficiency (feelings of deep fatigue, coldness, swelling and weight gain).
How do we support Spleen Qi?
Regulating our consumption of sugar (avoiding refined sugar and consuming natural sugars from starchy vegetables and fruit instead).
Taking time to rest the mind (meditation, yoga, prioritizing sleep)
Protecting the “windgate” or back of the neck using scarves to protect our immune system (the wind gate is where “cold” gets into the body).
Consuming nourishing and easy-to-digest foods that are warm and slow-cooked. Think soups and stews, bone broths, congee, root veggies, beef and chicken, warming spices like ginger, cardamom, cinnamon, etc. (hello, pumpkin spice!)
Consuming warm drinks like herbal teas like President’s Choice “feeling soothed” or “feeling revitalized” or “feeling energized” (all containing herbal combos that support Spleen and adrenal health).
Considering taking adaptogenic herbs like schisandra, astragalus, codonopsis, goji, Lycii and wild yam (some of which are ingredients in change of season soup) which support our adrenals and immune system.
Supporting the emotions, engaging in laughter, cuddles, and play more often to take the focus off the mind and thoughts and support deeper, spleen-y emotions like enthusiasm and child-like play.
Because fall hit so hard, I didn’t have time to get into my Spleen routines. I went from cold smoothies in the morning and lots of coffee to feeling tired, sluggish and congested–ugh!
Now that we’re well into October and Canadian Thanksgiving has past, I am remembering my Spleen practices. These involve spending time in the kitchen to create warm stews (cooking beef and vegetables with curry spices) and bone broths. I’ve given up coffee and started consuming copious amounts of green and herbal tea.
I’ve started taking herbs to support gut health like oregano and ginger.
I’ve gotten back into taking a probiotic.
And, finally, I’ve started taking my cod liver oil to get a healthy dose of vitamin D and vitamin A to support immunity and mood.
It’s also important to spend as much time outside as possible. Days are getting shorter and our exposure to mood-elevating and stimulating sunlight is getting sparser and sparser. We’re spending more time inside as we work on sedentary projects that tax the mind but leave the body unattended to.
While many patients state that they find it hard to get outside when the days cool off, I urge you to consider that cold exposure is the single most important thing you can do to prepare your mind and immune system for winter.
Get outside daily (without sunglasses–if appropriate for you) and go for a walk. Enjoy the fall colours. Protect your windgate. Breathe in the fresh air.
Cold exposure increases your body’s ability to create antioxidants. It also “hardens” the body for cold resilience making the transition to winter much more enjoyable.
And, of course, remember to tend to your spleen as the days get colder and shorter.
Did you know it can take modern medical research 17 to 20 years before it reaches mainstream medical practice?
Sometimes it takes us time to be sure and this means repeating study results over and over again with various populations. Sometimes, however it can take time to instill new consciousness into our habits and routines. We humans are creatures of habit and prone to bias. It can he hard to change our minds and change our ways, which can lead to even the most well-meaning and intelligent doctors making outdated recommendations or relying on old science.
For instance, have you ever been told (or know someone who’s been told) to avoid eggs for your cholesterol (facepalm). What about low-fat diets? Ridiculous as it may seem, this is still being said to my patients.
You get my point, right?
This brings me to the topic of supplementation for two nutrients that we North Americans are prone to deficiency in: Vitamin D and Iron.
Let’s start with iron.
Iron: Is needed to make hemoglobin in red blood cells. It shuttles oxygen around the body. We use that oxygen for cellular respiration (to make energy) in our mitochondria.
Low iron can lead to anemia (lack of red blood cells, hemoglobin and hematocrit).
Low iron can cause symptoms such as: low energy, low mood (dopamine), low thyroid function, feelings of cold, racing heart, anxiety, dizziness, weakness, hair loss, dry and pale skin, low stamina and exercise tolerance as the body is not able to move oxygen around the body to make energy.
So, what do you do when your iron is low? Supplement, right? Normally, I would have said yes.
That’s where things have changed for me.
So, I noticed that even if I recommended gentle iron supplements (iron bisglycinate or heme iron), patients wouldn’t take them. Even if they didn’t cause constipation (which the conventionally prescribed ferrous fumarate is infamous for) or other gastrointestinal symptoms, patients had a certain aversion to iron supplements that was hard to explain.
Further, sometimes they would raise blood iron levels and sometimes they wouldn’t. Sometimes they would raise levels and then levels would fall back down again.
It’s interesting to note that iron is the most abundant element on the planet, making up 35% of the Earth. It is fortified in commonly eating foods like bread and cereals. The problem is not iron intake, it is iron metabolism, or the way that iron is moved throughout the body.
We can have 10 times the amount of iron lodged in our tissues than is present and measured in our blood. And this isn’t good. Iron interacts with oxygen and causes oxidation (or “rusting”). This can cause inflammation of our tissues, like gut tissue. It can negatively impact our livers. We want iron safely stored in hemoglobin.
In order to get iron out of our tissues we need an enzyme call ceruloplasmin, which depends on the element copper. Copper is needed to get iron out of the tissues and into the blood in the form of hemoglobin so that it can be used to move oxygen to our mitochondria to give us energy.
Now, we also need preformed vitamin A (retinol, only found in animal foods) to load copper into ceruloplasmin.. (to get iron into hemoglobin so that oxygen can get to our cells, it’s like that song “The Farmer takes a wife”, haha). You get the picture.
Put simply:
Energy– > oxygen in mitochondria –> hemoglobin (with iron) –> requires ceruloplasmin (vitamin A and copper).
So, the key to supporting iron levels and energy production is not more iron! It’s the nutrients that help iron work properly in the body. Copper and Vitamin a, which are found (along with highly absorbable heme iron) in Beef Liver!
Interestingly enough Whipple, Minot and Murphy were awarded the Nobel prize in physiology and medicine in 1934 when they discovered that beef liver cured anemia and pernicious anemia (B12 deficiency).
Beef liver is rich in choline (supports the liver, especially fatty liver, cell membranes, brain health, digestion, gallbladder function, mood and memory), zinc, B vitamins and hyaluronic acid.
Very often we find that we are implementing too many interventions and the key is to go back to our roots: to nature and ancestral practices to solve our problems. Sometimes we don’t need more technology, but more nature. An ancestral food that few of us consume anymore (at least not regularly). Good old beef liver. I will tell patients to consume lightly cooked grass-fed liver or take it in a supplement form (which is what I do).
Vitamin D is actually a hormone. It regulates 900 genes in the body that are involved in bone health, immune function (supporting low immune function and autoimmunity) and mood.
We humans get vitamin D from the sun. Sun hits cholesterol in our skin and our skin makes vitamin D. This is the best way to get vitamin D. Therefore in sunny climates, get sun! Clothing and sunscreen blocks vitamin D, fyi. About 20 minutes a day of direct sun on 20% of your skin (t-shirt and shorts), can generally give you your daily vitamin D.
However, in the winter, our skin does not have access to sun exposure and we don’t make vitamin D. So what do we do? Well, up until recently I would have told you to take a vitamin D supplement, in the form of drops (as D is fat-soluble) to make sure that your blood levels of 25-hydroxyvitamin D (25-OH D) is >125 nmol/L.
However: vitamin D requires magnesium to be activated in the body (and most modern humans are notoriously deficient in magnesium). Sometimes low blood levels of D are actually an indication of low magnesium.
Further, high levels of supplemental vitamin D also deplete levels of vitamin A (or retinol). Vitamin A and vitamin D must be taken together as they are biological partners. In fact, one of the things that sunlight does is activate preformed vitamin A in the skin as well as activate vitamin D synthesis. Vitamin A helps activate Vitamin D receptors (and remember that vitamin A is responsible for iron metabolism as well).
The good news is that both vitamin D and vitamin A are found together in nature in Cod Liver oil (along with the antiinflammatory omega 3 fish oils EPA and DHA). So, I am more frequently recommending Cod liver oil as a vitamin D source along with magnesium to help support vitamin D metabolism in the body. We need to get vitamin D from a supplemental source in the winter if we’re not getting enough sun, however the precautionary principle will tell us that historic supplementation (what our Northern ancestors might have practiced) contains lots of wisdom.
Nutrients don’t work in isolation. They work in networks (just like our hormones and immune cells). We need copper and Vitamin A to regulate iron. We need magnesium and vitamin A to regulate vitamin D.
Isolating and supplementing with single vitamins and minerals may be indicated for some patients (going deep and narrow, particularly for people with pronounced and specific deficiencies), however in general I’m moving to a more holistic and ancestral prescribing practice with most patients when appropriate–this is where I see the current evidence pointing: to a more holistic vs. reductionist approach.
That being said, everyone is different and so all prescriptions are highly individualized. There are some people who these supplements are not indicated for or appropriate for and so alternatives are prescribed.
The reason my practice is built around 1:1 visits is because this is where the magic lies. In individualist prescribing. You are not the same as your neighbour. You have specific needs and considerations for your health.
I hope that makes sense. The world of nuritition is a fascinating subject. In order to stay on top of the current best practices it is my responsible to be on top of the research (sifting through the vast arrays of information) and flexible enough to pivot my approach when necessary.
I don’t practice the same way I did when I graduated. Or even the exact same way I did last year. It is important to keep things fresh and current and not let ego stand in the way of changing things for the better.
What do you think? Do you take beef liver and cod liver oil? How’s that been going for you?
We’ve been hearing quite a lot about The Science these days. So, what is science? How does science guide medical practice and naturopathic medicine?
The science council defines science as, “the pursuit and application of knowledge and understanding of the natural and social world following a systematic methodology based on evidence.” The answer is, science is a methodology.
It is applied in medicine through Evidence Based Medicine (EBM) which starts with the individual patient and incorporates: clinical expertise, scientific evidence (that best that exists according to a hierarchy), and patient values and preferences.
“Evidence medicine is the conscientious, explicit, judicious and reasonable use of modern, best evidence in making decisions about the care of individual patients. EBM integrates clinical experience and patient values with the best available research information.”
The Evidence-Based Pyramid
In EBM, evidence exists in a hierarchy, represented by the Evidence Based Pyramid (shown above). Animal studies are at the bottom, case reports (clinical anecdotes) somewhere in the middle and randomized control trials and meta-analyses (the Gold Standard of evidence) at the top.
Dave Sackett (the Father of EBM) et al. write in the British Medical Journal (1996),
“Good doctors use both individual clinical expertise and the best available external evidence and neither alone is enough.”
In addiction to scientific evidence, EBM must incorporate:
Patient values
A bottom-up approach (it is patient-centred, not guideline-centred)
The needs of the individual (EBM is not a one-size-fits-all formula)
Clinical expertise
The best available evidence: this does not mean using only randomized control trials. Sometimes the best evidence we have are case reports, historical and traditional use of an herb or animal studies. We still owe our patients the opportunity to see if a treatment works for them, especially if the risk of a given treatment is low.
As clinicians, we use our knowledge in different ways. We start with an assessment of the individual in front of us. This assessment takes into account the factors that influence this patient’s life, their lifestyle, their health condition and their overall health goals.
We then turn to clinical experience, research, our scientific knowledge and guidelines.
We share this information with our patient. Our job is to educate and convey the options so that the individual can provide informed consent. How does this knowledge fit into the patient’s life? How does it inform their choice?
Science is not a set of values. It is not a religion. We do not follow it.
Science provides us with a methodology for seeking the answers to questions we might ask about how the principles of nature, including the human body, are organized.
Science encourages us to ask questions and testing hypotheses in order to find answers.
It is never settled.
Most of all, science doesn’t tell us how to use scientific knowledge.
Our choices are governed by our goals, preferences and values.
So, “follow the sicence?”
No. Follow your goals, preferences, values and dreams.
And use science to help guide your way.
Reference:
Sackett, D. L., Rosenberg, W. C., Gray, J. M., Haynes, R. B., & Richardson, W. S. (1996). Evidence based medicine: What it is and what it isn’t. BMJ, 312(7023), 71–72.
