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.

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…

I struggle to understand...

I struggle to understand the strong presence of marijuana producers at Family Medicine Forum.
I don’t pretend to know all the answer but suspect the following:
1. They paid someone to be present.
2. They hope to make that money back and then some by being present.

The implicit messages to our student and physician membership may be that:
They can be counted to provide fair and unbiased information. (In contrast to say tobacco or alcohol producers)
They are producing a sufficiently “safe” product and their strong presence at FMF do not need to be balanced with an equal representation from those who believe marijuana may be a public health hazard.

I also struggle to understand the breakfast choices of simple carbs at FMF for ~6000 of my esteemed fellow family physicians and leaders of wellness.

Again I have no certainty but suspect:

A breakfast in line with Canada Food Guide 2019 cost more and the FMF fee needed to be allocated to a more important function and was insufficient.

The implicit messages to our student and physician membership may be that:

1. Healthy breakfast is important but there are more important matters.
2. Healthy nutrition may prevent and improve chronic physical and mental conditions for patients and physicians alike but family physicians do not have to be a good role model; may eat poorly when there are more important things to do such as learning how to treat diseases caused largely by eating poorly.

I think there are many object of human addictions; but two prominent examples are to sugar and to narcotics.

My perspective on Cycle of Addiction

Sugar addiction:  Diabetes Type 2 Epidemic (30% of Ontarians are diabetic or prediabetic in 2016)

1. Real need: Whole Foods & appropriate physical activity
2. Craving from needs unmet: hunger
3. Easy substitute: simple carbohydrates
4. Brief relieve from hunger
5. Craving recurs from needs unmet: hunger
6. Go to 3.

I struggle to understand why in this days of Type 2 diabetes epidemic, such glucose beverages or a simple carbohydrate breakfasts still remain so popular;  and why as a society we don’t seem to be all that alarmed? We focus on treating A1C to target with medications to prevent organ damage; we provide even more phenomenal and technologically advanced care once the kidney fails; but seem so bored with issue of self-management that has the potential to prevent diabetes and potentially save the system $19500 per year per person ( times 3.9 million Ontarians).

Opioid addiction: Opioid Crisis (9000 opioid related death in Canada since 2016; 2066 apparent opioid death in 2018; most death in 30ish year olds; 17 people hospitalized for opioid poisonings in Canada each day  2017)

1. Real need: wholefood, appropriate physical activity, understanding role of pain and suffering, ability to pay attention to what is truly important and self-compassion
2. Craving from needs unmet: pain & suffering
3. Easy substitute: opioids
4. Brief relieve from pain & suffering
5. Craving recurs from needs unmet: pain & suffering
6. Go to 3.

Where does marijuana fit in for most users?  My present (please correct me if I am wrong) thinking is that absorbing it daily is not a true need like being nourished by 400 grams of non-starchy vegetables daily.

While I suspect there must be some studies by now demonstrating its safety and benefits eagerly and earnestly shared by producers of such a profitable product; I am hesitant to abandon all caution.  I read not all that long ago Valium was promoted as safe and a way to safeguard the virtues of college girls who might otherwise succumb to crumbling moral standards. More recently oxycodone was prophetically promoted as the “one to start with and the one to stay with”.

Certain glucose infused beverage also contained cocaine in the past; now it’s just effectively promoted as “the real thing”.

Three challenges of addictions are: 1. Suffering caused by a real need unmet. 2. Side effects of the substitutes.  3. Vulnerability to other harmful substitutes.
I believe much more conversations at an individual and system level about the true nature of addiction are needed.

My conversation with patients about addiction.

I am sometimes asked by patient to prescribe benzodiazepines, cannabis or opioids.

My approach is similar for all medications and substances with potential addiction properties.
1. 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)
2. 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.
3. I then help them understand the lengthy list of other unintended and serious side effects of the substitute solution ( Eg.  Increased risk of falls in seniors; respiratory arrest, quality of life, etc.; I try to use examples most relevant to the individual.
4. I ask them and help them identify what it is their suffering the are hoping to alleviate.
5. I then offer them a real solution to their sufferings.  (Eg. my Basic Wellness Messages)
https://www.whatisharewithpatients.com/2019/02/a-family-physicians-basic-wellness.html?m=1
6. 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.

In my opinion, the key ingredient of addiction management are:
1. That I take the time.
2. That I understand addiction is a common humanity. ( remove stigma and judgement of which self-judgement or shame is most intense)
3. That I explain the mechanism of addiction in a way that can be understood by the individual
4. That I help find a real solution to replace a substitute.
5. That a reasonable plan is agreed upon to safely wean off the substitutes and apply the real solution.
6. That I use the capacity and power of “self-management groups” to help patients begin personal transformations.

Thank you for reading!

Tribute to our children who survived the Death Squad of El Salvador but did not survive the Canadian Opioid Crisis

A while ago, a good friend shared with me his story.  Shortly after arriving in Canada as a teen refugee from El Salvador, he along with a group of “new arrivals” were invited to a party.  At the party, they were all given the “choice” to snort lines from a table covered with cocaine. He politely declined and left with his little sister.  He said other than him and his sister, everyone in that original group of “new arrivals” have since died.

I know banning cocaine did not save his young friends.  I suspect legalizing cocaine would not have helped. I somehow also suspect a governance similar to Bill 2 would have been also futile.  

I believe giving individuals the “choice” to use cannabis without providing the knowledge of the nature of addiction represent not freedom but enslavement.  

I believe age is an inadequate predictor of awareness and understanding. The opioid crisis does not seem to spare individuals past their teens.

These rules and policies all seem to be a substitute for a real need.  A need for authenticity. A need to have conversations about addiction that brings more awareness.

I am often asked by patient to prescribe cannabis, benzodiazepines or opioids.

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 then help them understand the lengthy list of other unintended and serious side effects of the substitute solution ( Eg.  Increased risk of falls in seniors; respiratory arrest, quality of life, 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.

In my opinion, the key ingredient of addiction management are:

That I take the time.

That I understand addiction is a common humanity. ( remove stigma and judgement of which self-judgement or shame is most intense)

That I explain the mechanism of addiction in a way that can be understood by the individual

That I help find a real solution to replace a substitute.

That a reasonable plan is agreed upon to safely wean off the substitutes and apply the real solution.

That I use “physician-led self-management education and support groups” to help patients begin personal transformations.

Disclaimer:
Above are my personal opinions based on my clinical experience.

Patient Experience: I feel the new Canada Food Guide marks the beginning of a new era of wellness

I feel the new Canada Food Guide marks the beginning of a new era.

I am grateful that many patients are embracing the Basic Wellness Messages and empowering not only themselves but also others.

Make nature’s medicine a right for all Canadians

Hippocrates said “food is our medicine”.  I think some foods are still our medicine; and this medicine is the non-starchy vegetables.
The new Canada Food Guide promotes awareness of importance of nutrition.
To address food (vegetable) security issue, one proposition.
1.  Make non-starchy vegetables a right of every Canadian.  Eg. For those who are >65, under 25 or on welfare; make these nature’s medicine insured by provincial health ministry; redeemable at rate of 1lb per day.  The savings to health care cost will likely easily surpass cost of the program.
2.  A tax incentive that apply to 1 lb of vegetable per year a available for individuals choosing to buy these nature’s medicine.  Once again the cost savings would be phenomenal; even if human factors are ignored.

Let’s have more conversations! Grateful for Ginette Petitpas Taylor, MP for Moncton—Riverview—Dieppe

The new Canada Food Guide is an honest perspective to share with Canadians.  I am grateful for Ginette Petitpas Taylor, MP for Moncton—Riverview—Dieppe for launching the food guide to expand public awareness.  I believe the next step is to make conversation on wellness a prevailing culture in our communities, education and healthcare systems.  As a family physician, colleague, friend and citizen, I share a Basic Wellness Message whenever I can.

I am grateful that our children are able to grow up in this new era of awakening, gain  authentic perspectives and see things as they really are.😊  Let’s talk!

Is the nutritional crisis due to lack of money or knowledge or something else?

Is the nutritional crisis due to lack of money or knowledge or something else?

2016 CANADA 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 spend $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.

Is the problem with low vegetable intake financial or educational?

A breakfast consist of only processed simple carbohydrates was served to thousands of my family physicians colleagues at the Thursday session of Family Medicine Forum 2019.   The selection was cakes and beverages.

I can’t help but wonder, If I a family physician presumably a leader of wellness for my community do not make good nutritional choices in my own life, how can I help my patients.

What Canadians paid for vegetable vs processed food and beverages.

2016 CANADA 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 spend $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.

Is the problem with low vegetable intake financial or perhaps mostly educational?