Eat dark leafy greens and prevent gall stones

12 percent of the population has gallstones
In a US study that followed more than 13,000 adults over ten years, women with higher blood levels of vitamin C had a lower chance of developing gall bladder disease. This was not the case for men. 
Foods high in vitamin C include capsicum, cabbage, Brussels sprouts, cauliflower, broccoli, green leafy vegetables, tomatoes, citrus fruits, pawpaw, kiwi fruit, strawberries and pineapple. You could try vitamin C supplements, but studies are inconsistent and taking vitamin C supplements can increase the risk of kidney stones.

Alzheimer’s and Multiple sclerosis both may improves with increased vegetables and fruits

Eating a healthful diet comprising fruits, vegetables, and whole grains may be linked with reduced disability and fewer multiple sclerosis symptoms among people with the condition, according to a new study published in Neurology.

A recent study showed the older adults who eat leafy vegetables had slower rate of memory decline. Experts think this phenomenon could help with MS.  


Remember to eat your greens before it’s too late.
recent study out of Rush University found that participants who ate at least one serving of leafy greens a day had a slower rate of decline in memory and thinking skills versus those who rarely or never ate these green vegetables.

New research suggests that increased consumption of foods containing colorful carotenoids, particularly beta-carotene and lutein, may prevent or delay the onset of amyotrophic lateral sclerosis (ALS).

Plan to stay out of nursing home

Many seniors tell me they want to stay out of nursing home.
I made this log for them to track their self-management between visits.


Groups at Ajax Harwood Clinic


Dear all,
You are invited to attend our weekly groups to help you gain the essential skills and perspectives to overcome challenges with diabetes, weight management, smoking, substance dependence, challenging addictions, anxiety, depression, insomnia, loneliness, grieve, midlife crisis and emotional challenges of retirement.

I have come to the realization that almost all chronic physical conditions (Infections, Inflammations, Intestinal conditions, Obesity, Diabetes, Hypertension, High cholesterol, Heart attacks, Strokes, Kidney failures, Arthritis, Neurological conditions, Eye conditions, Memory loss, etc. ) and chronic mental conditions (childhood attention deficit disorders, behaviour disorders, eating disorders, anxiety, depression, etc.) can be managed if not prevented by a set of Basic Wellness Messages if understood and practiced.
I am a family physician interested in sharing a Basic Wellness Messages with anyone interested in discovering personal wellness and role modeling wellness for the greater community.

Wellness, Mindfulness training and stress reduction Groups at AJAX HARWOOD CLINIC

Mindfulness training: Tuesdays and Thursdays 8:00AM- 9:00AM

Healthy Lifestyle: Tuesdays 10:00AM - 11:30PM

Stress Reduction: Tuesdays 1:00PM - 2:30PM

“Getting Unstuck”: Tuesdays 3:00PM - 4:30PM

Cost: All groups are free or covered by OHIP.
Registration: please come 30 min earlier to complete registration if you are attending for the first time.

Address: 88 Harwood Avenue South, Ajax, Ontario, L1S2H6


Power to heal


I think more Canadians need to wake up from an unsustainable lifestyle of “I’ll eat what I want, do what I want and think what I want, without regard for consequences to my body, my community or the environment” and expect the politicians, teachers, physicians or someone else to fix it; and be surprised when it isn’t fixed.

Based on the little history I know, it seems that, at least in the past, calamity and suffering of enormous magnitude has been the painful cure and the cost of complacency.  I needn’t wait for politicians or wait for anyone else to come up with a solution. My individual and social responsibility is to apply influence where I can make a difference.  As a family physician, I am privileged with self-reliance and entrusted with the opportunities to share my perspectives. Regardless of politics, at least for now, my meaning is to have conversations about self-empowerment and social responsibility with everyone in my circles of influence.  I am a witness to many many narratives of personal growth and receive daily gratitudes from patients whose lives have improved; so I believe I am doing the right thing and will continue my exciting journey with gratitude and without expectations. I believe today, every individual, for the first time, can have the means to reach the masses.  This perspective emboldens me.

"Ask not what your country can do for you, ask what you can do for your country." - J. F. Kennedy
"Yes We Can" - Obama

I also like:

“If you are not part of the solution, you are part of the precipitate.” - Scott Trahan, Portland, OR USA

Risk of developing eczema or asthma in child is decreased with increased vegetable consumption by the child or the mother


I attended a lecture on atopic dermatitis (eczema) by an expert physician.  A comprehensive discussion ensued. pharmacological and then non-pharmacology management were discussed in detail.   The role of diet in eczema was touched upon but left me little confused.

So I did a quick research on the Internet and came up with some evidences suggesting that a diet rich in vegetables and fruits for either the child or the mother can both decrease risk of eczema (atopic dermatitis) and asthma in the child.


“A Traditional Diet Is Associated with a Reduced Risk of Eczema and Wheeze in Colombian Children”
Conclusions: A traditional diet might have a protective effect against eczema and wheeze in Colombian children, whilst intake of fast foods increases this risk.

“Effects of Fruit and Vegetable Consumption on Risk of Asthma, Wheezing and Immune Responses: A Systematic Review and Meta-Analysis”
Conclusion: In summary, overall, the findings suggest that high intakes of fruit and vegetables may have beneficial effects in asthma.

“Consumption of vegetables, fruit, and antioxidants during pregnancy and wheeze and eczema in infants”
Conclusions: Higher maternal consumption of green and yellow vegetables, citrus fruit, and β‐carotene during pregnancy may be protective against the development of eczema in the offspring.


I worked at emergency department on the weekend...

I worked ER on the weekend.
I was asked to see a 25 year old that was agitated and aggressive having had her opioid overdose reversed with naloxone. She said she wanted to leave. I asked her what is she going to do about her addiction. She said she wants to get out of here and go get her hamburger at McDonalds (she has a coupon) and then go home. She said she won’t have money to.. till Friday. I asked her what is her specialness. She then for the first time looked at me and said that she is good to others. I asked her if that means she feels others pain; and that she escapes her pain by using substances. She then started to tear up. I told her she is stuck but it does not have to be so.
I share the following perspectives with her.
1. Neurodiversity
2. Ability to choose the object of attention can be increased through meditation.
3. Object of her attention dictates her experiences… suffering or otherwise.
4. Anapana meditation by Goenka.
5. Vipassana retreat at Egbert Ontario.
She continue to cry and told me that she will study it. I emailed her a invitation to attend my weekly groups.
I believe I can easily be overwhelmed by the crisis and overlook non-pharmacological opportunities that can truly address the cause. So I remind myself that to effectively address the opioid crisis, a clear understanding of the root cause and its solution is necessary. 
On the whole, I believe opioid crisis is just one fatal symptom of a culture that is unwell. It is by no means the only fatal consequence ( Type 2 Diabetes, Increased Suicide being two more…) of a culture that has for some time forgotten the importance of individual and social responsibility. It is just one that is for now screaming at our collective conscience.
According to University and College Health Association:
65 percent of students reported experiencing overwhelming anxiety in the previous year (up from 57 per cent in 2013).
46 per cent reported feeling so depressed in the previous year it was difficult to function (up from 40 per cent in 2013).
13 per cent had seriously considered suicide in the previous year (up from 10 per cent in 2013).
2.2 per cent reported attempting suicide in the last year (up from 1.5 per cent in 2013).
Nine per cent reported attempting suicide sometime in the past (not restricted to last year).
Mental health challenges seem to be the norm rather than the exception; and does not seem to go away with time.
According to CAMH:
By age 40, about 50% of the population will have or have had a mental illness.
The Canadian health care budget is already in excess of $250 Billions. It would seem that some wellness perspectives are fundamentally lacking in the contemporary mindset.
I believe, as physicians we are all blessed with great minds, society’s love and trust deserved and sometimes undeserved and the precious perspective of self-empowerment. We collectively hold the power to heal our culture of illness and lead the transformation to a cultural of compassion and wellness.
I believe to do that I must be on the wellness journey myself. Then as a family physician, I have enormous influence on many individuals at every echelon of society. People with enormous influences come to me at their moments of suffering, open to new perspectives and mostly willing to take actions. What a privileged position with wonderful opportunities!
I think an effective and affordable solution may begin by challenging everyone to have wellness conversations at every opportunity:
1. Wide adoption of Mindfulness training programs (such as Mindfulness without Border Ambassador Program) and robust nutrition education at every level of the education system: schools, colleges and universities.
(I facilitate resilience groups for medical students and will speak at a local school parent teacher meeting on “addictions and mindfulness training”)
2. Wellness role modeling and promotion by our political leaders, community leaders, celebrities and other opinion makers.
( I will speak at a community garden club on “pain, suffering and illness”)
3. Wellness programs in government and private organizations.
(I am looking for opportunities to start “employee wellness programs” at the hospital)
4. Expanded availability of group psychotherapy in primary care and beyond. (I run several weekly groups for patients in my practice and community. If you like to learn to run these groups; just ask me how!)
Thanks for reading!

Interactive session of wellness discovery!

Good morning!

I am a family physician in Ajax.  I believe we can build a new culture of wellness.

Please join me for an interactive session of learning and discovery!
This Sunday March 31st 2019 10:00am to11:30am at the St. Andrew’s community center ( 46 Exeter Rd, Ajax, ON L1S 2J8) Come and discover your “specialness”; how your mind and body works; and how we can each make a difference in our family and community!  
Learn to deal with challenges in relationships, loneliness, anxiety, depression, problems with substances and insomnia.

Have a great day!

Carlos Yu MD, BMath., CCFP(EM), FCFP, CTH
Family Physician, Wellness Coach, Group Self-management Education Promoter

I am also helping a medical student who is trying to stop the diabetes type 2 crisis in Canada by promoting a counseling bot he built: Broccoli Healthy Eating Coach.


Please try this, comment and share!   

and please subscribe to my Wellness Blog:

Thank you so much!

Assistant professor, Queen’s University, Department of Family and Community Medicine
Assistant professor, McMaster University, Department of Family and Community Medicine
Lecturer, University of Toronto, Department of Family and Community Medicine


Patient feedback about this blog

I am grateful for this feedback from one of my patient.

Just a note:

Every one of these informative emails you circulate to your patients, reinforces the power we all have 
to take charge of our own well-being!  Thank you for taking the time to do this. 

Reiterating the importance of non-starchy vegetables at each meal - eating them first,
then the protein, then the carbs, will be such a good habit for all humans to get into.
 
Adding Dr. Carlos’s healthy smoothie at least twice a day, gives us a huge health bonus - 
Always start with kale and spinach, then add some fruit you fancy.  From here you can 
add flax seed flakes, nutritional yeast flakes, spring water, etc, etc.

Practicing mindfulness each and every day, is such a powerful tool to complete the 
total well-being we can all achieve. Thank you for offering this to us, your grateful 
patients, and we will certainly “spread the word” to others!

Sincerely, 
Patient”


Housecall: management of rash under breast

I went to make a housecall to see a bedbound lady with rash in the deep fold under her breasts.  Her son who takes exemplary care of her has tried different creams, talc and starch without success.
Solution: split sides of a pillow case to make a long rectangular cloth.  Fold it lengthwise and wrapped around her chest and push her breasts upwards as to hold the deep fold under the breast open to air.  I’ll check next week and see if that helps.

I came to Canada when I was 12 years old....

My mother and father immigrated from Taiwan to Canada with their 4 children. Mom worked as housekeeper; my father worked as a janitor. They raised their family while making minimum wages. They cooked every meal and lived simple. We were blessed with a country that welcomed us, where education was subsidized, healthcare was free and opportunities abound. I was surprised to find out that library books were free to borrow. We furnished our home with perfectly usable furnitures we’d pickup from curb side. It was easy life compared to where we had came from.
I believe while Canada is full of opportunities, it is the perspective of self-reliance I learned from my parents that allow me to benefit from the opportunities. I used to assume everyone had such perspective. Now I know it is not so. I think it is one important perspective I wish to share with those in need – equally as important as other social determinants of health.

Why I love to work at the emergency department?

I worked a shift in emergency department last night.

Yesterday a 24 year old brought in by police because she told her ex she wished to kill her self.  She had attempted over dose before.  She said she does not wish to die.  She said she did not buy enough Tylenol to overdose.   She was right.  She said she has a fear of abandonment and was trying to get her ex back.  She had been through DBT and mindfulness training.  I asked her what has she learned that she can use to help herself.  She told me she can meditate.

I told her to stand and let me sit in her chair (I was tired from running around anyways)
I then asked her to pretend to teach me how to meditate.  She chuckled and then laughed.  I saw a huge smile on her face as she began guiding me in meditation.  I just closed my eyes and had a little rest while she experienced a moment of freedom.  Her preoccupation created by empathy displaced by her empathy.
I told her she was good at it. We had a little chat about her experience in the following perspectives:

1. her own neurodiversity as being highly empathetic.
2. that she is different because everyone is different.
3. the object of attention  dictates the moment by moment experience
4. the purpose of meditation is to increase her ability to choose the object of attention.
5. equanimity and acceptance.

I sent her home.

Then I was asked to see a 25 year old that was agitated and aggressive having had her opioid overdose reversed with naloxone.  She said she wanted to leave.  I asked her what is she going to do about her addiction.  She said she wants to get out of here and go get her hamburger at McDonalds (she has a coupon) and then go home.  She said she won’t have money to.. till Friday.   I asked her what is her specialness.  She then for the first time looked at me and said that she is good to others.  I asked her if that means she feels other’s pain; and that she escapes her pain by using substances.  She then started to tear up.  I told her she is stuck but it does not have to be so.
I share the following perspectives with her.
1. Neurodiversity
2. Ability to choose the object of attention can be increased through meditation.
3. Object of her attention dictates her experiences... suffering or otherwise.
4. Anapana meditation by Goenka.
5. Vipassana retreat at Egbert Ontario.

She continue to cry and told me that she will study it and has nothing to lose.  I sent her home.



I email my blog to every patient I chat with and encourage them to reach out to me.

How can pharma help build a culture of wellness

As cannabis is “an allosteric modulator of μ- and δ-opioid receptors”; should it’s promotion be regarded similarly as that if opioids?

What about asking our pharma partners to put say 50% of their marketing genius and financial resources towards promotion of self-management education while promoting their products?

What I see lacking in the process of legalization of cannabis is any substantial public campaign to educate the public on the harm of the non-medical and medical use of cannabis.
As in the case of most medications, the promotion of and education on the medicinal use of cannabis is mostly funded directly or indirectly by the producers.
I read in Wikipedia, “..in vitro studies indicate CBD may interact with different biological targets, including cannabinoid receptors and other neurotransmitter receptors,[9][12]as of 2018 the mechanism of action for its biological effects has not been determined...It is an allosteric modulator of the μ- and δ-opioid receptors as well.”   
While I have no clue how CBD actually works, it  being both psychotropic and analgesic means it is a potential substitute or quick fix solution for dealing with pain and suffering.
My approach is similar for all medications and substances with potential addiction properties.
I explain to them that no one (for emphasis of course, I point out the obvious) including myself is immune to addiction; that given the situation, anyone can become addicted. (They usually don’t believe me at this point)
I then explain to them the mechanism or cycle of addiction (fear of some suffering/ craving for end of it; seeking a quick relieve / a substitute solution; relieve from suffering; effect of quick solution begin to wear out; triggers the fear of suffer... then the cycle’s intensity compounds); I talk about some real life examples; and there is no lack of stories.  By now, they begin to see how addiction applies to them personally.
I begin with discussion to help them discover the root of their pain and sufferings.  I then help them understand the lengthy list of unintended and serious side effects of the substitute solution ( Eg.  Increased risk of falls in seniors on psychotropics; respiratory arrest on opioids and benzodiazepines, cannabinoid hyperemesis syndrome, worsening anxiety or onset of psychosis associated with chronic use of cannabis, etc.)  I try to use examples most relevant to the individual.
I ask them and help them identify what is the suffering they are hoping to alleviate.
I then offer them a real solution to their sufferings.  (Eg. A Basic Wellness Messages)
In my experience, above approach has resulted in various satisfactory outcomes; many embrace the knowledge and come to attend my wellness groups and learn more about the Basic Wellness Messages.

Some are disappointed but still respect the time spent and reasoning; none leaves with a quick fix or substitute solution without a clear understanding and an agreement on a solid plan to eliminate the substitute with the real solution.
One young man asked me for lorazepam to help him sleep.  He had been suffering panic attacks and had not slept much for 6 nights.  He managed to struggle through each night using the Breath Awareness Meditation I had taught him.  He said he was able to sleep last using the lorazepam his mom gave him. He said her mom wants me to give him a prescription for the same.  I reminded him about his experience with Cannabis. About a year ago, he disregarded my warning that cannabis will likely worsen his anxiety and had persisted on using cannabis to deal with anxiety.  He finally did stop using cannabis as his panic attack did increase and were associated with frightening attacks of globus. On his last visit to me he was deeply grateful for being able to finally quit cannabis using BAM.  He said the globus was so frightening that he will never touch cannabis again.
I then told him the use of lorazepam as a substitute solution will only worsen his problem with panic attacks.  I also told him that if I give him lorazepam I would have nullified his 6 nights of valiant struggle that prevailed using BAM.  I reassured him that if he is no worse for wear after 6 nights of panic attacks; he will be just fine again. I reminded him how much stronger he had become.  I reminded him of his success overcoming his dependence on cannabis. I reminded him to try leaning into his discomfort and welcome the experience with acceptance and equanimity.  He finally told me hesitantly that he will trust me and give it a try and overcome his anxiety using BAM.

Another patient (John) reflected that he now feels a peace that was never possible before.  He used to be afraid to leave the house in the day for the fear that he will become enraged at strangers and cause them bodily harm.  Now John meditates daily with his wife and eats 400 grams of non-starchy vegetables per day. He enjoys great relationships with his wife, daughter and his grandchildren.  He told me he will grow a vegetable garden this spring.
Over the years, he managed to wean himself off opioids, alcohol while on cannabis.  He told me he made cannabutter and baked brownies. He gradually weaned himself off the brownies as well.  Next he quit tobacco. He now manages his chronic back pain without any substance but by addressing his real need for wholefoods, appropriate physical activity, a sense of equanimity with everything (including his back pain), an improved ability to pay attention to what is important and a sense of self-compassion.

For type 2 diabetes, John’s HbA1C was 11.1 on SGLT, DDP4 and metformin in 2016. His last HbA1C was 5.5.

https://www.whatisharewithpatients.com/2019/02/physician-relationship-with.html?m=1

What is the relationship between Climate Change and the Opioid Crisis

To truly address the opioid crisis a clear understanding of the root cause and the true solution is necessary; anything else short of that may just be more “substitutes” that hides the inconvenient truth.
I believe opioid crisis is one of many symptoms of a culture of sickness. It is by no means the only fatal consequence of a culture that has for some time forgotten the importance of individual and social responsibility. It is just one that is for now screaming at our collective conscience. It foreshadows greater calamities. I used to think that I am already trying my best and I can’t be expected to do much more than to whine and complain. Somehow I suspect I am not alone in my opinion. Yesterday, I listened to a speech delivered at the EU conference last month by the 16 year old Swedish Climate Change activist, Greta Thunberg. It was a sobering message that helped me understand my own version of narcotic. It is the narcotic of optimism that somehow the millennials and the echo generation will be more enlightened and stop the climate change, the opioid crisis, the diabetic crisis and all the other crisis I have helped perpetuate by my stuporous inaction.
I have not asked her, but I think I know what Greta will tell me to do about the Opioid Crisis or the Type 2 Diabetes Crisis….
Stop messing around with more studies or rely on others or the government to solve the problem! Take personal responsibility! Deal with my own addictions! Eat a mostly plant-based diet! Be a good example for others! Start wellness conversations at every opportunity. 
I believe, as physicians we are all blessed with great minds, society’s love and trust deserved and sometimes undeserved and the precious perspective of self-empowerment. We collectively hold the power to heal our culture of illness and lead the transformation to a cultural of compassion and wellness.
I believe to do that I must be on the wellness journey myself. Then as a family physician, I have enormous influence on many individuals at every echelon of society. People with enormous influences come to me at their moments of suffering, open to new perspectives and mostly willing to take actions. What a privileged position with wonderful opportunities! I can run groups for self-management education. I can make sure each patient knows the potential of 5 oz of non-starchy vegetables in prevention of Type 2 diabetes, Alzheimer’s disease and many many other diseases. I can help patients understand the role of pain and the true nature of addiction. I can empower them to share their wellness perspectives with their family, friends. I can collaborate with them to become changemakers in their circles of influence.
If a 15 year old Greta Thunberg can take on Climate Change; as a family physician I can surely find ways to do my part to promote wellness and compassion.

How to prevent catching a cold this spring: Eat 5 oz non-starchy vegetables 3 times a day before meals

Of the included studies, flavonoid supplementation ranged from 0.2 to 1.2 g/d. Overall, flavonoid supplementation decreased URTI incidence by 33% (95% CI: 31%, 36%)


https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4863266/

My reflection from Alzheimer’s disease to Climate Change


My perspectives on the 50 million dollars in the Canadian federal budget for Alzheimer’s diseases.
I suggest, by spending 50% of that money on nutritional campaign to prevent Alzheimer’s may eliminate need for many billions of healthcare spending, caregiver work and sufferings of affected.
Everyone seems to agree that an ounce of prevention equals pound of cure;  but we currently spend less than 3% of healthcare spending on prevention. There are already ample evidence on what we need to do.  
Evidence:
Type 2 diabetes is a well known risk factors for Alzheimer’s.
30% on Canadians are diabetic or prediabetic.
Study demonstrate that seniors eating most dark leafy greens have 11 years younger brain.
1 in 2 of us will have Alzheimer’s by age of 85.
In the case of Climate Change, Greta Thunberg (15 year old Climate activist, potential Nobel prize nominee, worth looking up on YouTube) challenges us(adults) to grow up and take individual responsibility and do what we can each do.
I have not asked her, but I think I know what Greta will tell me to do about the Alzheimer’s crisis or the Type 2 Diabetes Crisis….
Stop messing around with more studies or rely on others or the government to solve the problem!  Take personal responsibility! Eat a mostly plant-based diet! Be a good example for others! Start wellness conversations at every opportunity.

As a family physician, I have enormous influence on many individuals at every echelon of society.  They come to me at their moments of suffering, open to new perspectives and mostly willing to take actions.  What a privileged position with wonderful opportunities! So, at every meeting, I make sure each patient knows the potential of 5 oz of non-starchy vegetables in prevention of Type 2 diabetes, Alzheimer’s disease and many many other diseases.  I then encourage them to all share the same message with their family and friends.

I believe, as physicians we collectively hold the power to heal our culture of illness and lead the transformation to a cultural of compassion and wellness.  To do that we must be on the wellness journey ourselves.

I have been blessed with many perspectives and the power to produce value.  There is no U-Haul behind a hearse. I think it’s time I create more value for others and put my resources behind what really matters.  I am not going to wait for the government to do something; it simply hasn’t worked! If 250 Billion of annual health care spending got us to our present state; perhaps, money is not the problem but the problem.

If a 15 year old Greta Thunberg can save humanity by taking on Climate Change; as a family physician I can surely do my part to promote wellness and compassion.

An antidote to hate.

The antidote to hate is compassion. I also see compassion and self-compassion as being inseparable and the remedy to many mental health challenges. 
To me, mental health challenges seem to be the norm rather than the exception; and does not seem to go away with time; and solution may involve a cultural transformation.
According to University and College Health Association:
65 percent of students reported experiencing overwhelming anxiety in the previous year (up from 57 per cent in 2013).
46 per cent reported feeling so depressed in the previous year it was difficult to function (up from 40 per cent in 2013).
13 per cent had seriously considered suicide in the previous year (up from 10 per cent in 2013).
2.2 per cent reported attempting suicide in the last year (up from 1.5 per cent in 2013).
Nine per cent reported attempting suicide sometime in the past (not restricted to last year).
According to CAMH:
By age 40, about 50% of the population will have or have had a mental illness.
The Canadian health care budget is already in excess of $250 Billions. It would seem that some wellness perspectives such as compassion are fundamentally lacking in the contemporary mindset.
For me compassion is a state of awareness rather than knowledge. In my experience, this state of awareness is a process and is coming to me gradually through mindfulness practice and being open to others perspectives. To provide this context for myself and patients in my practice and in my community, I run three weekly self-management psychotherapy groups where participants experience mindfulness training and learn authentic experiences from each other. These groups are insured services, rapidly-accessible, rolling-enrolment and capacity-building. As a result, these groups are open to everyone. I also use these groups to provide experiential learning opportunities for medical learners interested in running groups. (Contact me if anyone is interested to know more or to attend!)
I think wide adoption of such group therapy may be one affordable way to bring about a culture of compassion and wellness:
1. Wide adoption of Mindfulness training programs (such as Mindfulness without Border Ambassador Program) and robust nutrition education at every level of the education system: schools, colleges and universities.
2. Wellness role modeling and promotion by our political leaders, community leaders, celebrities and other opinion makers.
3. Wellness programs in government and private organizations.
4. Expanded availability of group psychotherapy in primary care and beyond.
Thank you for reading!

Mental health challenges seem to be the norm rather than the exception

According to University and College Health Association:


65 percent of students reported experiencing overwhelming anxiety in the previous year (up from 57 per cent in 2013).
46 per cent reported feeling so depressed in the previous year it was difficult to function (up from 40 per cent in 2013).
13 per cent had seriously considered suicide in the previous year (up from 10 per cent in 2013).
2.2 per cent reported attempting suicide in the last year (up from 1.5 per cent in 2013).
Nine per cent reported attempting suicide sometime in the past (not restricted to last year).

Mental health challenges seem to be the norm rather than the exception; and does not seem to go away with time.

According to CAMH:
By age 40, about 50% of the population will have or have had a mental illness.

The Canadian health care budget is already in excess of $250 Billions.  It would seem that some wellness perspectives are fundamentally lacking in the contemporary mindset.

I think an effective and affordable solution may begin by challenging everyone to have wellness conversations at every opportunity:

1.  Wide adoption of Mindfulness training programs (such as Mindfulness without Border Ambassador Program) and robust nutrition education at every level of the education system: schools, colleges and universities.
2. Wellness role modeling and promotion by our political leaders, community leaders, celebrities and other opinion makers.
3. Wellness programs in government and private organizations.
4. Expanded availability of group psychotherapy in primary care and beyond.

Economic incentives for healthier foods through Medicare and Medicaid could generate substantial health gains and be highly cost-effective.

Look at this new study!

https://journals.plos.org/plosmedicine/article?id=10.1371/journal.pmed.1002761


Background: Economic incentives through health insurance may promote healthier behaviors. Little is known about health and economic impacts of incentivizing diet, a leading risk factor for diabetes and cardiovascular disease (CVD), through Medicare and Medicaid.
Conclusion: Economic incentives for healthier foods through Medicare and Medicaid could generate substantial health gains and be highly cost-effective.

Why physician find great meaning in providing palliative care?

When I carry the mega delusion of immortality, I am helplessly tossed between cravings and fears.  I think participation in the end of life care is the privilege of experiencing a little bit of mortality with out having to die first.   Through mindfulness, I can internalize these precious perspectives;  then enjoy each moment with gratitude and curiosity; and finally experience a sense of equanimity and meaning beyond the tangible.

What about legalization of cannabis?

What I see lacking in the process of legalization of cannabis is any substantial public campaign to educate the public on the harm of the non-medical and medical use of cannabis.
As in the case of most medications, the promotion of and education on the medicinal use of cannabis is mostly funded directly or indirectly by the producers.
I read in Wikipedia, “..in vitro studies indicate CBD may interact with different biological targets, including cannabinoid receptors and other neurotransmitter receptors,[9][12]as of 2018 the mechanism of action for its biological effects has not been determined...It is an allosteric modulator of the μ- and δ-opioid receptors as well.”   
While I have no clue how CBD actually works, it  being both psychotropic and analgesic means it is a potential substitute or quick fix solution for dealing with pain and suffering.
My approach is similar for all medications and substances with potential addiction properties.
I explain to them that no one (for emphasis of course, I point out the obvious) including myself is immune to addiction; that given the situation, anyone can become addicted. (They usually don’t believe me at this point)
I then explain to them the mechanism or cycle of addiction (fear of some suffering/ craving for end of it; seeking a quick relieve / a substitute solution; relieve from suffering; effect of quick solution begin to wear out; triggers the fear of suffer... then the cycle’s intensity compounds); I talk about some real life examples; and there is no lack of stories.  By now, they begin to see how addiction applies to them personally.
I begin with discussion to help them discover the root of their pain and sufferings.  I then help them understand the lengthy list of unintended and serious side effects of the substitute solution ( Eg.  Increased risk of falls in seniors on psychotropics; respiratory arrest on opioids and benzodiazepines, cannabinoid hyperemesis syndrome, worsening anxiety or onset of psychosis associated with chronic use of cannabis, etc.)  I try to use examples most relevant to the individual.
I ask them and help them identify what is the suffering they are hoping to alleviate.
I then offer them a real solution to their sufferings.  (Eg. A Basic Wellness Messages)
In my experience, above approach has resulted in various satisfactory outcomes; many embrace the knowledge and come to attend my wellness groups and learn more about the Basic Wellness Messages.

Some are disappointed but still respect the time spent and reasoning; none leaves with a quick fix or substitute solution without a clear understanding and an agreement on a solid plan to eliminate the substitute with the real solution.
One young man asked me for lorazepam to help him sleep.  He had been suffering panic attacks and had not slept much for 6 nights.  He managed to struggle through each night using the Breath Awareness Meditation I had taught him.  He said he was able to sleep last using the lorazepam his mom gave him. He said her mom wants me to give him a prescription for the same.  I reminded him about his experience with Cannabis. About a year ago, he disregarded my warning that cannabis will likely worsen his anxiety and had persisted on using cannabis to deal with anxiety.  He finally did stop using cannabis as his panic attack did increase and were associated with frightening attacks of globus. On his last visit to me he was deeply grateful for being able to finally quit cannabis using BAM.  He said the globus was so frightening that he will never touch cannabis again.
I then told him the use of lorazepam as a substitute solution will only worsen his problem with panic attacks.  I also told him that if I give him lorazepam I would have nullified his 6 nights of valiant struggle that prevailed using BAM.  I reassured him that if he is no worse for wear after 6 nights of panic attacks; he will be just fine again. I reminded him how much stronger he had become.  I reminded him of his success overcoming his dependence on cannabis. I reminded him to try leaning into his discomfort and welcome the experience with acceptance and equanimity.  He finally told me hesitantly that he will trust me and give it a try and overcome his anxiety using BAM.

Another patient (John) reflected that he now feels a peace that was never possible before.  He used to be afraid to leave the house in the day for the fear that he will become enraged at strangers and cause them bodily harm.  Now John meditates daily with his wife and eats 400 grams of non-starchy vegetables per day. He enjoys great relationships with his wife, daughter and his grandchildren.  He told me he will grow a vegetable garden this spring.
Over the years, he managed to wean himself off opioids, alcohol while on cannabis.  He told me he made cannabutter and baked brownies. He gradually weaned himself off the brownies as well.  Next he quit tobacco. He now manages his chronic back pain without any substance but by addressing his real need for wholefoods, appropriate physical activity, a sense of equanimity with everything (including his back pain), an improved ability to pay attention to what is important and a sense of self-compassion.

For type 2 diabetes, John’s HbA1C was 11.1 on SGLT, DDP4 and metformin in 2016. His last HbA1C was 5.5.

Do we really want to pay $200 Billion annually in taxes to avoid eating non-starchy vegetables?

At the checkout of grocery store I was behind a metabolically challenged shopper buying bags of cookies and processed food.  It got me thinking about the 30% pre-diabetes and diabetes rate in Canada destined to cost us an additional $200 Billions on healthcare expenditure that is largely preventable through daily consumption of 400 grams of non-starchy vegetables ( & little fruits).
According to Shaun Loney, author of “The beautiful bailout - how a social innovations scale-up will solve government’s priciest problems”:
Annual health care cost per Canadian = $6604
Annual health care cost per Canadian with diabetes = $26416; Difference per year = $19812
I live in a country where we have collectively and implicitly agreed to bear the burden of chronic diseases caused by our own poor dietary habits.  In 2016 Canadians imported 3.7 billion worth of vegetables
http://www.agr.gc.ca/eng/industry-markets-and-trade/canadian-agri-food-sector-intelligence/horticulture/horticulture-sector-reports/statistical-overview-of-the-canadian-vegetable-industry-2016/?id=1501890793620

The value of vegetables produced in Canada  rose 2.0% to $1.2 billion in 2017.
https://www150.statcan.gc.ca/n1/daily-quotidien/180212/dq180212a-eng.htm

The food and beverage processing industry is the second largest manufacturing industry in Canada in terms of value of production with shipments worth $105.5 billion in 2014

Canada has positive trade balance at $2.6 billion in 2014 for processed food and beverages.
http://www.agr.gc.ca/eng/industry-markets-and-trade/canadian-agri-food-sector-intelligence/processed-food-and-beverages/overview-of-the-food-and-beverage-processing-industry/?id=1174563085690

Assuming CANADA don’t export vegetables; then Canadians paid  $4.9 billion for vegetables in 2016

Assuming food processing and beverage industry did not change between 2014 and 2016, then Canadians spent $102.9 billion for processed food and beverages.

Hence, in 2016, Canadians’ spending on vegetable is <5% compared to spending on processed food and beverages.

So the problem with low vegetable consumption seems to be pandemic - possibly a problem for the rich and the poor.
So are we really willing to pay an unnecessary 200 Billions annually and suffer the burden of illness to perpetuate our habits of non-starchy vegetable deficiency?  If not, what can we do to create a wellness mindset?

As an individual and healthcare provider, I would role model wellness with every meal I eat, discuss the importance of nutrition at every patient and student encounter and run weekly Self-management education groups.

As a taxpayer, I would like to see my tax money go towards wellness promotion through every public institutions: Education, Healthcare and Governments.

As a wellness advocate, I would like to appeal to private corporations to put their marketing ingenuity and capital behind the creation of an economy based on wellness rather than illness.

Let’s create a wellness economy for ourselves, our children and grandchildren…

What is happiness, complacency and oneness

I am grateful for my life and my life as a family physician. I tell my patients happiness are transient moments and so are sadness. T...