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In October 2019, Dr. Steven Taylor, clinical psychologist and professor at the University of British Columbia, published his eerily-timed book, The Psychology of Pandemics, just weeks before the first cases of COVID-19 were discovered in Wuhan. On this week’s episode, Dr. Taylor joins guest host Dr. Jack Muskat, Medcan’s clinical director of mental health, to discuss the lessons we can learn from pandemics and predict what the future of mental health may look like post-COVID. He also explores the potential for an oncoming Roaring ‘20s.  https://www.eatmovethinkpodcast.com/podcast/ep-70-post-pandemic-psychology   LINKS To learn more about Dr. Taylor, head over to his website.  Find his book, The Psychology of Pandemics: Preparing for the Next Global Outbreak of Infectious Disease, on Amazon.  Dr. Taylor also co-wrote a recent study in the Journal of Anxiety Disorders, exploring post-traumatic growth in relation to COVID-19. Read this CTV News article exploring “cave syndrome,” in which Dr. Taylor is quoted.  And check out this feature in Smithsonian Magazine that studies the end of the 1918 pandemic to consider our post-pandemic existence.  INSIGHTS On a psychological level, pandemics are incredibly polarizing and tend to bring out extremes in people. With COVID-19, for example, on one end of the spectrum, we’re seeing highly anxious people who have become extremely sheltered — a.k.a. those with COVID stress syndrome. On the other end, are people who think this pandemic is nothing more than an exaggerated hoax. Most of the research we have is around those who are anxious and suffering with intrusive thoughts and a compulsive need for reassurance. “COVID stress syndrome fits as an adjustment disorder,” Dr. Taylor explains. “That means, when the pandemic is over, many people who have the syndrome [will be] at risk of developing chronic anxiety problems as a result.” [time code: 00:11:18.27] People are resilient and are capable of bouncing back, even in the toughest of circumstances. Even better? “There’s also pre-COVID research suggesting that some people will not simply bounce back to where they were, they will grow as human being,” Dr. Taylor explains. Dr. Taylor studied this phenomenon, called post traumatic growth, early on in the pandemic, and found that many people (who hadn’t been infected with COVID) were feeling more resilient and experiencing a greater appreciation for their lives. While this is great news, Taylor has discovered that these feelings of growth can be self-deceptive; the longer the pandemic has gone, the more people have realized that their overall mental health has worsened and they had actually been trying to talk themselves into feeling better. [time code: 00:16:35.22] We need to think of COVID like a marathon, according to Dr. Taylor. Often, we view the last third of a marathon as the most difficult, but the hardest part is actually everything leading up to arriving at the starting line. “COVID-19 is getting us to the starting line for the next pandemic. We need to be prepared — we weren’t for this one,” he says. “One thing we have to understand is that pandemics are not a once-in-a-lifetime phenomenon. There have been 20 pandemics over the past 200 years. And now with growing population, growing mobility, airline travel, climate change and so forth, we can expect to see more pandemics in the decades, or perhaps years, ahead. So this is a wake up call for us.” [time code: 00:19:52.12] As for what our post-pandemic lives will look like? Expect a miniature version of the Roaring ‘20s—though it will probably be less exuberant and shorter lived than the original. “Humans are inherently social creatures—that’s etched into our genomes,” says Dr. Taylor. “When all these restrictions are lifted, many people, probably most people, will go back out and resume their social lives.” With that will likely come larger events and increased spending. [time code: 00:24:55.06] That said, it’s important to remember that COVID has only acted as a catalyst towards certain things, like less frequent visits to the movie theatre. “COVID [has accelerated] all the trends that were in place beforehand—the trend of working from hone, watching Netflix instead of going to the cinema … the tendency to make your apartment a pleasure palace,” says Dr. Taylor. Now, that doesn’t necessarily mean it’s the end of movie theatres forever— there’s still a large social aspect to it, of course—while other things, like restaurants, Dr. Taylor believes, will have no problem bouncing back. [time code: 00:26:08.03] Right now, it may feel impossible to picture a post-pandemic world, where you’re going to concerts and eating at restaurants again. This is just anchoring bias, or when you rely on current conditions to predict the future. So, for example, if it’s gloomy outside, you may feel bummed out. The same thing has happened during lockdown. But don’t worry, it will pass. “I think people will be surprised at the extent to which they rapidly resume normal, busy social lives,” says Dr. Taylor. [time code: 00:27:22.04]

Here’s a little known secret: germs are good for you. Every single one of us has a complex and unique microbiome that lives on us and in us. It’s made up of microbes—things like bacteria and protozoa. Our microbiome plays a huge role in our health and, as microbiologist and University of British Columbia professor Brett Finlay has discovered, it is even connected to non-communicable illnesses like asthma or cardiovascular disease. That’s why pandemic-bred habits like cleaning surfaces with antibacterial wipes, or chronic use of hand sanitizer, can be so problematic: they kill bad germs, and good ones, too. Which prompts the question: is our COVID-caused mania for germ killing messing up our microbiome? In conversation with Medcan chief medical officer Dr. Peter Nord, Prof. Finlay answers these questions—and more. https://www.eatmovethinkpodcast.com/podcast/ep-69-finlay-microbiome Links You can find Brett Finlay on Twitter.  Read the paper he lead-authored for PNAS on the hygiene hypothesis, COVID-19 and its impact on the human microbiome here.  He’s also written two books: The Whole-Body Microbiome, co-written with gerontologist (and his daughter) Jessica M. Finlay, and Let Them Eat Dirt.  Watch this interview with Finlay, in which he discusses building a healthy gut microbiome. Check out “Can We Learn to Live with Germs Again?,” a New York Times feature on the human microbiome and the need to get comfortable with being exposed to bacteria.    Insights Our path to slowly damaging our microbiomes started 125 years ago, back when Robert Koch and Louis Pasteur made their seminal discoveries (that microbes caused disease, and that killing microbes could kill disease, respectively). These discoveries lead to sanitation, hygiene, antibiotics and vaccines — which, to be clear, are all good things. But what scientists eventually realized is that when we try to kill microbes, we kill all of them, even the ones that make our microbiomes healthy. This led to David Strachan’s hygiene hypothesis, which essentially argues that we live too cleanly and that the rise of things like allergies and asthma are linked to our reduced exposure to germs. [Time code: 03:25]   According to Finlay, newer research has found that microbes actually have an influence over non-communicable illnesses, like cardiovascular disease, too. For example, people who are born via C-section—and are therefore not exposed to the same microbes associated with vaginal delivery—have a 25 percent higher chance of getting asthma; they also have a 30 percent higher chance of being obese. “There’s actually quite a tight link,” he says. “It’s a fascinating thinking experiment.” Some research even indicates that your environment and proximity to people plays a part in your microbial health—that’s why spousal rates of inflammatory bowel disease are actually pretty high, even though you are, of course, not related to your partner. In other words? Be careful who you’re kissing.  [Time code: 08:29] COVID has changed all of us—microbiomes included. We shy away from close contact with people, we’ve been (necessarily) wearing PPE for a long time now, and we’ve mostly been inside for the past year, meaning we’ve been exposed to far less germs than we normally would have been. Finlay worries that this will have the biggest impact on children and the elderly, when microbes have the largest effects on our overall health, which could lead to higher rates of things like asthma and obesity in the coming years.  [Time code: 15:20] We’ve all been a bit more hyper-aware of our hygiene during the pandemic, but Finlay cautions against letting our changed behaviours become permanent habits. Of course, we should all continue to follow public guidelines, socially distance and wear PPE as long as the risk of COVID remains high. But if you’re still wiping down your groceries or Amazon packages, it’s long past time to stop that—disinfectant wipes don’t stop the spread of COVID, anyway. And during non-pandemic times, Finlay’s hand-washing rule is simple: “I generally say soap and water before dinner, but lay off the hand sanitizer. All it does is kill the good microbes on your skin.”  [Time code: 21:13]So what can we do to fix our microbiomes? Luckily, there are a few things. First, is eating well; Finlay recommends a Mediterranean-style diet that’s full of fruits, vegetables and legumes, and low on dairy, fat and sugar. Next is getting outside—don’t be afraid to let your kids roll around in the grass or get a little dirt under your fingernails. You probably won’t be surprised to learn that exercising has a beneficial effect too, as it can increase your anti-inflammatory microbes. And you need to lower your stress levels, too, as stress can actually cause an inflammatory response in your microbes that can lead to other diseases. “Post-COVID, chill out,” Finlay says. “Just sit back, play with the kids, go outside and eat well, and maybe you’ll add a decade to your life.”  [Time code: 22:54] And if you take probiotics—or you’re tempted to start—know that they likely won’t have a big overall effect on your microbiome. Finlay compares them to trying to find a new pair of running shoes: you walk into a store and are bombarded by options. You don’t just grab the cheapest pair and then walk out. Because probiotics are not regulated, companies tend to be looser about the claims they’re making. “We just have to realize we’ve impacted our microbes and realize that there are things we can do to help them, because they’re our friends and they’re going to help us down the line,” Finlay says.  [Time code: 27:44]

As the global vaccination campaign continues, we continue to have questions. Is it safe to mix and match different vaccines? When is the optimal time to get my second dose if I’m aiming to maximize the resulting immunity? And: Will COVID-19 ever end? Medcan’s Medical Advisory Services team of expert physicians join host and CEO Shaun Francis to break down the latest information and provide need-to-know guidance. Featured in this episode is Medcan chief medical officer Dr. Peter Nord, clinical director of travel medicine Dr. Aisha Khatib and senior medical consultant Dr. Matthew Burnstein.   To enlist the services of Medcan’s Medical Advisory Services, email corporatesales@medcan.com.   https://www.eatmovethinkpodcast.com/podcast/ep-68-covid-conclusion   LINKS  Here are the preliminary results from the U.K. study on mixing and matching vaccines and the Spanish one, which both suggest combining doses may be safe.    Read the latest survey results from the International Air Transport Association that found 81 percent of people will feel confident about travelling again once they’re fully vaccinated.    INSIGHTS  As noted by CEO Shaun Francis, World Health Organization guidance suggested that countries keep borders open, yet most countries are pursuing policies that are 180 degrees away from that. The MAS docs note that, while closing borders and limiting travel — like the bubble between the Atlantic provinces and in Australia — has been relatively effective in reducing the spread of COVID, it can only ever work as a temporary solution that buys time. “You can’t keep the borders closed forever and just hope the virus goes away,” says Dr. Nord. This is the time to boost vaccination rates and immunity, because, if not, infections will become widespread again as soon as the borders reopen. [Time code: 10:16] We’re still not certain on the results of mixing and matching vaccines, but the early data look promising. A recent study from the U.K. analyzed what happens when AstraZeneca is first dose and Pfizer is the second. Preliminary results indicate that the vaccines remain effective, though there did seem to be an uptick of mild side effects, like fever and headaches, that last for a few days. A similar study conducted in Spain found a strong immunoglobulin response from mixing doses. “There’s no reason to believe one can’t safely combine vaccines,” says Dr. Burnstein. “It’s just that we don’t have the real-world experience yet to prove it.” [Time code: 12:49]   When will the world be ready to travel again? Potentially very soon, for people who have been fully vaccinated, at least. According to the International Airport Transport Association (IATA), most people feel safe about travelling after receiving both doses of the vaccine; more than 80 percent feel more confident about travelling with some kind of document that proves their vaccine status. Scottish travel agency Skyscanner has also found that people are more likely to travel to a country that also has a high vaccination rate. “People are looking for safety, and they’re looking for that kind of immunity,” says Dr. Khatib. “But we’re just not quite there yet. I think it’s going to take a little bit of time.” [Time code: 16:02-20:16]   While vaccine-rich populations may be eager to travel soon, Dr. Khatib also reminds us that it will take much longer for the entire industry to bounce back. In fact, IATA estimates that travel rates won’t fully return to pre-pandemic levels until 2023. This follows past travel trend lines during international crises: Global travel fell 30 percent during the SARS outbreak, then took about 11 months to recover; during the 2008 economic crash, travel dropped 50 percent and took 19 months to rebound. [Time code: 20:55] When’s the best time to receive your second dose? Lots of discussion about that in Canada, where the wait has been extended from the manufacturers’ initial guidelines. However, new trials with the AstraZeneca vaccine are indicating a stronger immune response if there’s a slightly longer wait between doses, up to 16 weeks. “It's actually showing in the real world to be actually more protective, immune-wise,” says Dr. Khatib. [Time code: 24:16]The good news is that all the COVID vaccines continue to be effective against new variants of concern, including the B.1.617, which originated in India. That said, it’s estimated that just a single vaccine dose is only 33 percent effective against the B.1.617 variant, while there’s about an 81% efficacy rate with both doses. “We’re going to start to see a push to get those second doses out,” to make sure we’re better protected against emerging variants, explains Dr. Khatib. [Time code: 26:15]   So when does COVID end? “That begs the question of a fourth or fifth wave,” says Dr. Nord. “Only when the globe literally has a 75 percent vaccination are we going to be able to see this thing die.” Until then, there will likely continue to be flare ups, but at least we know we have health measures to address rising cases as vaccination efforts continue. “It will probably become like the cold or the flu,” adds Dr. Khatib. “We just have to get it tamped by vaccination, but I don’t think we can actually ever eradicate COVID-19 at this point.” [Time code: 27:05]

Regenerative cell therapy may one day help us all grow our own replacement parts. People with heart failure could get a transplant for an entirely new heart, made out of their own cells. Burn victims, or people who just want wrinkle-free skin, could grow new sheets of the stuff — from their own tissues. Younger cells may provide better raw material for these therapies than older versions, and so a commercial cell banking industry has sprung up to provide the required cryogenic storage for about the price of a Netflix subscription. But is it worth it? To help listeners decide, Medcan Director of Genetics Allison Hazell interviews Drew Taylor of Acorn Biolabs, a Toronto commercial cell banking start-up, with a dissenting opinion from Aaron Levine of the International Society for Cell & Gene Therapy.  https://www.eatmovethinkpodcast.com/podcast/ep-67-cell-banking   Links Visit the Acorn Biolabs website to learn more about regenerative cell therapies and commercial cell banking.   Hazell and Taylor discussed platelet-rich plasma (PRP) and other regenerative therapies for sports injury. A good explainer on PRP. An Acorn Biolabs blog post on PRP and future therapies for sports injuries. A Mayo Clinic primer on stem cell-based therapies.   Learn more about Tel Aviv University 3-D printing that human heart.   Find Acorn Biolabs CEO Drew Taylor on Twitter and LinkedIn.    Here’s a good profile of Drew Taylor. Plus a good synopsis of Taylor’s baseball career. In this episode, Hazell mentions the International Society for Cell & Gene Therapy’s Statement of Concern speculative commercial cell banking services. Here’s the statement in full.    The ISCT rep who gave the dissenting opinion is Aaron Levine. He’s an associate professor at Georgia Tech. Learn more about his career. Follow him on Twitter.    Want to learn more about your genetic background and gain insight about future disease risk? Allison Hazell’s Medcan Genetics team has many different services for you.    INSIGHTS    Revolution is right around the corner Regenerative cell therapy and commercial cell banking services are growing more popular, but they’re based on technology that’s been around for decades. So why now? According to Taylor, more than 1,000 clinical trials are happening in the field of cell and gene-based therapies. The Acorn Biolabs founder likes to compare it to the Wright brothers. They successfully flew the first powered aircraft in 1903. An aeronautics industry and commercial flight took decades longer to develop. Stem cell science is undergoing a similar curve. [Time code: 7:10]    PRP and 3D printing of human replacement parts Currently, a goal of regenerative cell technology is to concentrate the growth factors and nutrients in platelet-rich plasma (PRP) and put it at the site of an injury. The idea is that this will enhance the inflammatory response in the surrounding cells and encourage healing. It’s used in soft-tissue sports injuries as well as skin-rejuvenation in dermatology. Another potential use for commercial cell banking is the 3D printing of replacement parts for the human body. For example, at Tel Aviv University, they took a biopsy of skin cells, multiplied them and were able to 3D-print a miniature human heart. “It was a major milestone,” Taylor says. [Time code: 9:30]   Taylor’s argument that young cells are better for cell therapies “We need to be thinking about strategies that we could deploy to allow people to actually secure a better cell population to use as a starting material,” Taylor says of his work at Acorn Biolabs. In the past, what he’s found is that adults who are in pain will start looking at regenerative cell therapy. The problem? At that point, the cells and tissues in that area already are in a diseased state. What Taylor wants to help people do is get ahead of these problems by collecting younger, healthy cell samples and storing them for potential further use. “We really need to be thinking about this in advance,” Taylor says. “To be thinking about strategies we [can] do to allow people to secure a better cell population to use as a starting material.” [Time code: 13:55]   Counterpoint Aaron Levine is an associate professor at Georgia Tech and a member of the International Society for Cell & Gene Therapy, where he was a Vice Chair on the Presidential Task Force on the Use of Unproven and/or Unethical Cell and Gene Therapies. The taskforce concluded that “these companies — that will take your cells and freeze them today for potential use sometime in the future — are too far ahead of the science.” Basically, in Levine’s view, the science is not yet there to justify cell storage. “These companies may be over promising to their customers,” Levine says. “The reality is that the vast majority of these cells will remain frozen indefinitely and never used clinically.” [Time code: 23:15]   Critical thinking Taylor disagrees with Levine's point that cell banking is speculative — he argues that the science is there and will continue to advance. Not all cell-banking services are created equal, Taylor says. Levine’s investigation also was completed before Acorn Biolabs was founded. “There is a massive difference between companies that offer cell-banking services,” Taylor says, adding that it’s likely that certain organizations probably are over-promising. “Personally, I would be mortified to be grouped in with some of them.” [Time code: 26:47] Practical applications Although you can never make guarantees in science, regenerative cell therapy is already showing real-world results, Taylor says. This type of therapy could help heal athletic injuries, or be used as an aesthetic skincare treatment. But there are bigger potential uses, too. For example, he says, in Canada 24 patients have had keratinocyte and fibroblast cells harvested and leveraged to create sheets of skin, which were then used to treat severe burns. There are also about a dozen people in North Carolina who have had 3D bladders created using their own cells and implanted in their bodies. “We’re already seeing cells being leveraged in some of these therapeutics,” Taylor says. “So I’d push back a little bit” on Levine’s points. [Time code: 27:40]

When the holistic psychologist Dr. Nicole LePera decided that traditional therapy wasn’t working for her, or her clients, she began exploring the mind-body connection, and the responsibility of what she calls “self healers” to exert effort every day toward bringing about a desired life transformation. Dr. LePera eventually used social media to create a community of motivated #selfhealers, and wrote a book, the recent New York Times bestseller, How To Do the Work. Here, Dr. LePera is in conversation with Medcan’s clinical director of mental health, Dr. Jack Muskat.  https://www.eatmovethinkpodcast.com/podcast/ep-66-how-to-do-the-work   LINKS Dr. Nicole LePera is on Instagram, Facebook and YouTube.    Her website is www.yourholisticpsychologist.com.    LePera’s book is How To Do the Work: Recognize Your Patterns, Heal from Your Past, and Create Your Self. Buy it at Indigo and Amazon.  Medcan provides mental health-promoting services for clients featuring appointments with a team of psychologists led by Clinical Director Dr. Jack Muskat. Learn more. To arrange an appointment, contact 416.350.5959 or mentalwellbeing@medcan.com.   INSIGHTS Mind matters. The power of positive thinking is real. In her book, Dr. LePera shares the story of one man who received a terminal cancer diagnosis, and was told he only had three months left to live. He was, understandably, quite distraught over the revelation and, sure enough, he died a few months later. But when an autopsy was conducted, it was discovered that he had been misdiagnosed. He didn’t have cancer. The implication? The mind can create self-fulfilling prophecies. Dr. LePera knows this is an extreme example, and there are many other factors at play, of course. But, in her opinion, this devastating story makes something very clear: “It’s important to acknowledge that the mind is an incredibly powerful tool for healing,” she says. If you continuously give into overwhelmingly negative thoughts, you risk getting stuck in certain cycles. [2:15]   Key concepts. Dr. LePera calls herself a “holistic psychologist,” but what does that mean? For her, it’s a two-part definition. “One [is about] acknowledging that we’re not just a mind, and that our body is somehow separate. We’re an integrated being,” she explains, adding that those two elements are always in communication with each other. The second part? It’s about taking that interconnectedness and looking at how it can affect our overall health. “Holistic means honouring the whole being — mind, body and soul — and understanding that many of the symptoms we experience are likely coming from an imbalance in one of those deeper areas of being.” [05:45]   New perspectives. In her book, Dr. LePera details how to use self-healing to improve your life. As the title suggests, it’s all about “doing the work.” The first step is to “honour the change that comes when we begin to actualize new choices,” she says. It’s not just enough to think differently — you have to commit to a daily action that will eventually create change. “A lot of us are very [habitual] in how we feel about ourselves and the role we play in our relationships. We have to learn how to shift out of that autopilot,” Dr. LePera says. “[It’s a] choice to create consciousness. We need to actually learn how to bear witness and make those new choices in real time.” [06:55]   Learn to let go. Knowing how to do the work is one thing. Actually doing it is completely different. It can be especially challenging when our subconscious is inherently illogical — we are creatures of habit and crave the safety of familiarity. When we make a change, it’s natural for us to resist it, and before we know it, we’re reverting back to the old habits we were trying to fix. But that feeling of discomfort is necessary. It’s the signal that we’re doing the work. “Expect resistance and know that it’s coming from our subconscious as its best attempt to keep us safe,” Dr. LePera says. “We can thank it in that moment, but still choose to show up and make those new choices that will inherently create more unfamiliar experiences and resistances, yet now [we] can empower [ourselves] because we know what it is.” [10:00]   Support system. Much of Dr. LePera’s work may be focused on self-healing and doing your own work, but that doesn’t mean it’s an entirely solitary exercise. Having a strong, supportive community surrounding you is still important — wherever you can find it. “We heal in community,” she says. “For some of us, the best communities, or the safest communities, that we can find right now exist online. They maybe aren’t in our neighbourhoods or in our immediate communities, so going online and finding that safety is incredibly important.” [12:40]    Upside down. It’s not a surprise that COVID-19 has interrupted all our patterns and disrupted our lives. This can cause us to feel unsafe, which is further complicated by any other challenges, insecurities or grief that we’ve had to face during the pandemic. In situations like this, we have to “learn how to cultivate safety” by being present and conscious. She recommends engaging in a sensory activity, like focusing on your breathing or lighting your favourite candle to hone in on the present moment. [18:55] Accept this. No matter how much you may want to try, you cannot change another person. “When we feel like we want to change a relationship, or a relationship isn’t working for us, we think, ‘Okay, if this person would do [this] differently, I would feel differently,’” Dr. LePera explains. But you can only empower yourself to make changes. Everyone else has to do the work for themselves. If necessary, you can create boundaries or separations in relationships to change their function in your life. [25:25]

It is an activity associated with cutting your risk of death from COVID by two and a half times, and cutting risk of developing severe COVID by two times. That activity is exercise, and the study that established its power as a modifiable risk factor against the coronavirus was led by Dr. Robert Sallis, past president of the American College of Sports Medicine and director of the Sports Medicine Fellowship program at California’s Kaiser Permanente Medical Center. In this episode he’s in conversation with Medcan chief medical officer Dr. Peter Nord.  https://www.eatmovethinkpodcast.com/podcast/ep-65-how-to-protect-against-covid   LINKS The study lead by Dr. Robert Sallis in the British Journal of Sports Medicine: https://bjsm.bmj.com/content/early/2021/04/07/bjsports-2021-104080 New York Times’ Well blog story on the COVID/Fitness study: https://www.nytimes.com/2021/04/14/well/move/exercise-covid-19-working-out.html Exercise is Medicine blog post by Bob Sallis and James Sallis that provides good background on some of Sallis’s frustration with the public health response to COVID: https://www.exerciseismedicine.org/support_page.php/stories/?b=959 Resources tying fitness level and exercise to immune function: https://www.exerciseismedicine.org/support_page.php/covid-19-and-exercise1/ Medcan director of fitness Stephen Salzmann and fitness manager Anna Topali hosted a webinar about how to incorporate exercise snacks throughout your workday. Check it out.  To create a personalized exercise training regimen and work with some of the country’s best trainers, check out virtual training by Medcan Fitness.     INSIGHTS  Get moving: Dr. Sallis’ study divided study participants into three groups — those who didn’t exercise at all, those who exercised a little bit and those who achieved at least 150 minutes of moderate exercise per week. Compared to the group that received the most exercise, the “no exercise” group was two and a half times as likely to die from COVID and twice as likely to be hospitalized, as well as twice as likely to be admitted to intensive care. [07:20] There’s no time like the present: “There has never been a better time to start an exercise program,” Dr. Sallis says. “Short of getting the vaccine, this is the single most important thing you can do to protect yourself from COVID... protect yourself against the next variant, or the next pandemic down the line. This is a wake up call. You need to pay attention to it and start getting active to protect yourself.” [08:22]  Words matter: Dr. Sallis is disappointed that physical inactivity hasn’t been included as a major risk factor for severe COVID in key messaging from medical leaders. “All of us have been a bit disappointed that the uptake has been slow. Certainly, you don’t hear it coming from Anthony Fauci’s mouth, or the CDC—the CDC still does not list it on its website, that physical inactivity is a major risk factor,” he says, adding that the World Health Organization, at least, does include physical inactivity as a major risk factor for severe COVID. “We’re always running behind on our messaging.” [11:56]   “The take home message for everybody around the world is that you just need to walk,” Dr. Sallis says, noting that the ideal pace is hard enough to prevent you from singing, but moderate enough that you can still talk. A brisk 30-minute walk five days a week will do it, but you can also break it up throughout the day: Taking the stairs instead of the elevator, or parking farther away in the parking lot. [13:39] Rethinking lockdowns: Dr. Sallis disagrees with closing outdoor athletic or recreational facilities like parks, hiking trails, tennis courts and golf courses. Outdoor venues where you can partake in physical activity, while distanced and masked, are safe, he says. In fact, people should be encouraged to take advantage of them. In Dr. Sallis’s mind, if big-box stores  can stay open, then we should be able to figure out accommodations for exercise, too. “These [venues] are essential to life. Physical activity is essential to life,” he says. [18:21]   Proactive patient care: Dr. Sallis believes the medical profession should treat exercise as a prescription, one that would optimally be attempted before pharmaceutical treatments. For example, if a patient is struggling with depression, the doctor should explore their fitness habits before prescribing an antidepressant. After all, studies have shown that exercise can “dramatically improve” depression. “You have to really sell it like you would [sell] Prozac,” he says. [19:22]   Shifting mindsets: Closely connected to the idea of “prescribing” exercise is moving the medical field, where possible, away from a focus on pills and procedures. “We are so driven by pharma,” Dr. Sallis says. The message of this pandemic has been: Stay inside until you get a vaccine. Dr. Sallis wishes the messaging would have been different. “It should have been: ‘Until you get a vaccine, you need to try to walk everyday, because that’s the single best defense short of a vaccine,’” he says. Plus, there’s evidence that exercise improves one’s immune response overall. “We have shown that [in people who exercise], the flu vaccine works better. I’ve got to believe that the COVID vaccine is going to be similar.” And that means: Keep up those daily walks even after the pandemic is over. [22:07]

Corporations around the world are confronting flagging mental health among their employees. The world’s largest wellness company, Johnson & Johnson, has since 2016 had a mental-health ambassador, Craig Kramer, who has spurred incredible changes within and without his employer. In conversation with Medcan’s chief people and growth officer, Bronwen Evans, Kramer describes the crisis of mental health in the pandemic, and the opportunity to create long-term change in the way employers manage the mental wellness of their employees.  https://www.eatmovethinkpodcast.com/podcast/ep-64-mental-health-the-other-pandemic   LINKS: Video: TEDxJnJ talk about Kramer’s mental wellness journey. Article: My First Two Years as J&J’s Global Mental Health Ambassador Other podcasts featuring Kramer: On a podcast called Global Health Pursuit, Kramer argued that we need a militant mindset to drive change for global health care. Listen on Spotify or Apple Podcasts.   Video: “The Mental Health Moment”, a talk for the U.S. Health Action Council.  Resource: The World Economic Forum has compiled a list of articles and research to arm people looking for statistics and best practices to encourage mental wellness in workplaces. Check it out.    Medcan provides mental health-promoting services for clients featuring appointments with a team of psychologists led by Dr. Jack Muskat. Learn more.    INSIGHTS: File under best practices: Consider creating an employee resource group for those living with mental illness. When Kramer first began advocating to improve mental health care, he gave a talk about what he was doing for J&J employees and included an appeal for volunteers. Soon he had 400 of them — about 390 more than he had expected to get. Kramer believes it may have been one of the first employee resource groups created within a company for people who live with mental illness (which is one out of four people, Kramer says), or for those who are acting as caregivers to those who live with mental illness (about two out of four people, Kramer says). The group’s also become the fastest-growing employee resource group in J&J history, featuring representation from 79 countries around the world. Other employers have picked up the idea and now there’s a fraternity of these groups working together to address workplace mental health. (Time code 7:00) Silver linings: There’s a positive side to the mental health struggles people are experiencing through the pandemic: “Before the epidemic hit, we were getting a lot of traction, a lot of openness to talk about this,” Kramer says, “but there were still a lot of people who didn't get it or, or thought that it was, you know, something that was really just about people being weak in character and not really having an illness of any kind.” The pandemic has opened the eyes of the people who didn’t get it, according to Kramer. Now, he says, “it's hard to find somebody who doesn't understand that their own mental health can really fluctuate based on the external environment, but also on your own internal genetic and family history. It's made this conversation a lot easier to have. And as we compete for resources, to address mental health, we are getting a lot more traction.” (12:25) Argument: For employers, Kramer believes caring for employee mental wellness is smart business. “Numerous studies from the World Bank and others have shown that every dollar you spend on mental health promotion in the workplace leads to five to 10, maybe more, dollars of return, because mental illness is the leading cause of disability worldwide,” Kramer says. In the workplace, according to Kramer, this manifests as absenteeism, turnover, disability, short-term disability, long-term disability and something called presenteeism — when you show up to work but your head is not really in the game. “I can tell you,” Kramer says, “in the thick of my daughter's struggles… it's hard to go to work and really focus when you're worried that your loved one might not make the day or you're worried that the care they're getting is not really appropriate.” (13:23) Thought-provoking metaphor: Kramer’s dad recently had cancer. He’s survived, and in the experience, Kramer was struck by the difference between what exists for those with cancer, and the way mental illness is treated. “The primary care doctor knew a lot about [the cancer] and stayed with us on the journey,” Kramer says. “[He] actually joined phone calls with the specialists, the oncologist, the radiologist, the surgeon. There were decades of studies of this particular kind of cancer. And we were able to get first, and second, and third opinions that all kind of lined up and gave us a good sense of where we were.” Mental health is very different, says Kramer. “Primary care doctors know very little about mental health,” he says. “And so they're reluctant to help you on the journey, or unable to help you in the journey. A lot of the specialists are freelancing, and using their own approaches, some of which work and some of which don't. It's not driven by data and rigorous clinical studies by and large. So as a consumer, it's hard to know where to start.” Kramer believes that the world that we want to create is one where mental health is treated just like cancer, or heart disease. (19:00) Another thought-provoking metaphor: Kramer believes the drive for marriage equality forms a template for how things may proceed for the drive to improve mental health care. ”For a long time, our society did not support [marriage equality],” says Kramer. “But there came a point where enough of us knew somebody we loved, who couldn’t marry the person they loved, [so] that almost overnight” things changed. “And you know, we're using the same strategy for mental health, we want to raise these voices.” Kramer believes we face an enormous opportunity now. “Some people call this the mental health moment,” he says. “Now is the time. All the pieces are aligned in the right place for us to make a lot of progress, but we've got to push. I think if you wait, other things will crowd out this issue.” (24:45)

As the author of the recent New York Times bestseller Hunt, Gather, Parent, Michaeleen Doucleff was already examining the culture and practice of mothering when the pandemic hit. Then everything changed for us all. Here, Medcan’s Dr. Daiva Barnicke, mother of two young children, explores Doucleff’s story as well as the pandemic’s impact on motherhood in a frank conversation that could have therapeutic benefits for struggling moms.  https://www.eatmovethinkpodcast.com/podcast/ep-63-motherhood   LINKS Michaeleen Doucleff is on Twitter @foodiescience.    Doucleff’s book is Hunt, Gather, Parent: What Ancient Cultures Can Teach Us About the Lost Art of Raising Happy, Helpful Little Humans. Here’s the New York Times book review. Buy it at Indigo and Amazon.    “There’s a Better Way to Parent: Less Yelling, Less Praise”: An interview with Doucleff in The Atlantic.    The NPR blog to which Doucleff contributes is called Goats and Soda.    Medcan provides a Child and Youth Assessment designed to empower children to eat better, move better and think better. Learn more.     INSIGHTS The pandemic meant the closing of the preschool that Doucleff’s daughter, Rosy, attended. So Doucleff went from parenting her daughter for three or four hours a day, to up around 14 hours a day. Meanwhile, she also had the deadline for Hunt, Gather, Parent to meet. So Doucleff was forced into a position where she had to take the book’s advice, particularly the bit that suggests that North American parents should provide their children with more autonomy, and interfere less in their lives. “I really started to put those ideas into practice throughout the day, and I have to tell you, it saved us,” Doucleff says. (4:50)     Doucleff began thinking about her parenting in 2014, when National Public Radio sent her to Monrovia, Liberia, in Africa, to cover the peak of the Ebola Outbreak. “I saw these parents that were in this incredibly stressful situation,” Doucleff recalls, “and yet they were very calm and composed.” She was struck by the way parents in Liberia were being faced with something that was very harsh and hard, and yet the moms and dads there were able to keep their composure with their children. “I just started to think, maybe there’s a different way of doing things, that is more productive,” Doucleff says. (5:50)    Doucleff studied parenting norms among the Mayan people on the Yucatan peninsula of Africa. She observed that moms among the Maya were far more likely to get their children involved in household work. As a result, the children were more likely to demonstrate the quality of acomedido — the skill of paying attention and then acting in a helpful way. For example, while she was in one Maya mother’s home, Doucleff saw a 12 year old walk into a kitchen and begin doing the dishes, without being nagged or even asked. She believes it’s possible to develop acomedido at any age, because Doucleff realized that both she and her husband needed to develop acomedido as well. (14:40)   Child-centred activities are something that Doucleff believes harm a child’s ability to develop acomedido. Such events as four-year-old birthday parties, kiddie museums, trips to the zoo — things parents do only for their children, and never would do on their own — “these things erode a child’s motivation to help,” Doucleff says. “They teach a child to learn that they are special, that their role in the family is to do these special activities.” Doucleff dispensed with all child-centred activities, and instead started to go about her life as she would normally, as an adult. “Just stop doing things you don’t want to do,” she says. The idea is that life revolves around the adults in the family, rather than the family revolving around the children. (18:00)    We often think children need to be entertained, and that it’s the parents’ duty to occupy children’s time. To keep them busy in some way. “No other culture in the world believes this,” says Doucleff. “And this is definitely not the way children evolved.” Get rid of that mindset, Doucleff says. “That’s doing them a disservice… A lot of life is boring, and hard work. And being able to occupy yourself, but also take initiative — that’s what we’re taking away from them when we constantly organize their schedules.” (20:15)   Power struggles between her daughter and Doucleff were an ongoing problem, and made Doucleff angry with her daughter. But then Doucleff researched parenting norms in Iqaluit. “Kids are just these irrational, illogical beings that don’t have emotional regulation, and don’t have social skills,” the Inuit elders told her. “It’s the job of the parent to show [kids]  proper behaviour.” Seeing the parent-child relationship in that light helped Doucleff to curtail her anger with her daughter, and be more successful at modelling appropriate behaviour. (27:00)     In the US and Canada, one psychologist told Doucleff, parents teach kids to figure out what they want in life and go get it, which has its benefits. But Doucleff believes the single-minded devotion to goal attainment is done at the expense of teaching children to be helpful, and cooperative, and good family members. “And that's really what we needed during the pandemic, right?” Doucleff asks. “Kids to be working on the team with their parents… Moms have way too much on their shoulders. It’s time that the kids give to the mom, and help the mom. And in that process, the child learns all these skills, both physically how to do things, but also emotionally how to connect and bond with their parent in a way that they hadn't before.” (30:55)

COVID-19 provokes all sorts of questions. Can I see my grandchildren after the first dose? How does the first vaccine shot affect risk of severe COVID? When will vaccinations push down ICU admissions? Every week Medcan’s Medical Advisory Services team of expert physicians get together to discuss trending topics. They develop advice to share with their corporate clients, which include some of the world’s biggest brands. The docs are witty, and the meetings entertaining, but more to the point they feature up-to-the-minute guidance of the sort that we’re all craving. So we recorded one of their sessions and cut it into an episode.   Featured in this episode is Medcan chief medical officer Dr. Peter Nord, clinical director of travel medicine Dr. Aisha Khatib, senior medical consultant Dr. Matthew Burnstein, associate medical director Dr. Jason Abrams and Dr. Alain Sotto, who, in addition to his role at Medcan, is also the occupational medical consultant for the Toronto Transit Commission. To enlist the services of Medcan’s Medical Advisory Services, email corporatesales@medcan.com. INSIGHTS It’s not yet known how likely a partly or even fully vaccinated person is to transmit the coronavirus, says Dr. Aisha Khatib. “So we really still need to maintain those public health measures to help decrease the risk of entering into a bigger fourth or even fifth wave down the road. Plus, Dr. Nord says, no vaccine is 100% effective. “We're assuming that there is a reduced transmission with vaccination, but we don't know that for sure.” In other words, some risk will remain that even the fully vaccinated can transmit the virus. (5:00) The variants of concern continue to live up to their name. According to Dr. Alain Sotto, case fatality rates have tripled among 20-29 year olds for those in Brazil infected by the P.1 variant, from 0.04% to 0.13%. Dr. Nord points out that an outbreak of P.1 is ongoing in British Columbia and that, while the vaccine does appear to be protective against current variants, some risk does exist for future variants to require additional vaccination measures. (7:25) Speaking about VIPIT, or the Vaccine-Induced Prothrombotic Immune Thrombocytopenia associated with the AstraZeneca and Johnson & Johnson vaccines, Dr. Jason Abrams puts the relative dangers in perspective. Risk of blood clots is higher for those taking the oral contraceptive pill, or those who smoke, compared to the blood clot risk from the AstraZeneca vaccine, Dr. Abrams says. “Frankly a lot of people are not getting the AstraZeneca vaccine—they are waiting,” agrees Dr. Nord. “And what people have to understand is that there’s risk associated with that as well.” (9:30) Rapid antigen tests like the Abbott Panbio, which provide results in about 15 minutes based on a nasal swab, should be one of the mainstays of preventing outbreaks at workplaces, says Dr. Alain Sotto. The test protocol also provokes questions from the curious. People are wondering: Will those who have been vaccinated produce a positive result on a rapid antigen tests? The answer, Dr. Sotto says, is no. Later, Dr. Khatib says that rapid antigen tests will detect cases that are too early in their infection cycle to be symptomatic. In fact, she argues that screening with the tests may have prevented the Amazon warehouse outbreak. (13:15, 16:50) More clarification about what you can change after you get your first dose: According to Dr. Sotto, the first dose provides about 80% efficacy in the real world. Dr. Nord clarifies: About 80% of the people given their first doses did not receive any symptoms of COVID-19 infection. But unfortunately, Dr. Burnstein says, the first shot does not change your behaviour. Internally, the first dose makes people feel less anxious about getting infected, because they are more protected than they were before. But externally they shouldn’t change their behaviour at all. (23:00) Dr. Khatib serves in a COVID-19 testing centre and has personally encountered people who have tested positive for the virus after they received both the first and second doses of the vaccine. They’ve tended to have no symptoms, or very mild symptoms. “But the question is, are they going to be at risk to pass that on to the next person?” Dr. Khatib asks, with the implication that transmission after vaccination is possible. (28:25)    How long are we protected against COVID-19 after being fully vaccinated? Dr. Abrams says that researchers don’t actually know how long the immunity lasts yet. “The results so far based on studies are encouraging,” says Dr. Abrams, “that there is protection of at least several months.” Which raises the question: Are we going to need booster shots to maintain immunity against COVID-19 at some point in the months or years after we’ve been fully vaccinated? Dr. Khatib believes the likelihood is high. The COVID booster could even be an annual thing, like the flu shot. (29:20) LINKS Referenced in this episode is this CMAJ article about rapid antigen testing by Dr. Isaac Bogoch and others, which argues for the mass deployment of the point-of-care tests as a public health strategy to minimize COVID outbreak risk. Here’s information about Medcan’s rapid antigen testing service.  A news report about the outbreak in the Amazon warehouse mentioned in the episode. Additive to the rapid antigen testing content in this episode is Joshua Gans’ essay, “What does vaccination mean for rapid screening?” The Takeaway is the YouTube video series that features Medcan docs providing guidance on trending medical topics. This one provides Dr. Nord’s advice on the AstraZeneca vaccine, and whether to get it. Link.

Curious about how to lose weight? Most people think that when you want to drop pounds, you should eat better and exercise more. But Duke University Associate Professor and internationally recognized pioneer in human metabolism Herman Pontzer argues that exercise — while really important for mental and physical health — plays no part in weight loss. In his new book, Burn: New Research Blows the Lid Off How We Really Burn Calories, Lose Weight, and Stay Healthy, Pontzer says the only way to move the number on the scale is by consuming fewer calories. Here, Pontzer is in conversation with Dr. David Macklin, director of weight management at Medcan. It’s a revealing and entertaining conversation that will have you rethinking how you eat, move and live.