On our radar: the brain food scale

The latest science on nutrition that protects your mind

By Tania Haas

Leaders in nutritional psychiatry have created a helpful and evidence-backed food scale that ranks nutrients by their role in nourishing and protecting our brains.

The buzz was strong when the brain food scale was previewed to a standing-room only audience at this year’s American Psychiatric Association Annual Meeting. While not yet published, its creation represents growing medical support for food as a part of the clinical approach to the treatment and prevention of depression, anxiety, and other mental health conditions.

Spotlight on nutrients critical for brain function

The scale breaks down foods to a micro level and lends insight on each nutrient’s role on the mind, formalizing some of the data nutritional scientists and registered dietitians have been referencing in practice.

The researchers’ scale directly links vitamins and minerals with brain function, such as:

• Vitamin A and the biochemistry of mood, memory and learning

• Vitamin B12 to mood and memory

• Vitamin D to mood, motivation and memory

• Magnesium and brain protection

• Vitamin E with the delayed onset of Alzheimer’s disease

Choose these critical nutrients for brain health

Foods that rank high on the scale are rich in brain essential nutrients such as: Omega-3 fatty acids, magnesium, calcium, fiber and vitamins B1, B9, B12, D, and E.

The greatest sources of brain essential nutrients can be found in whole foods such:

• fatty fish like mackerel, anchovies, sardines, salmon and herring (Omega-3 fatty acids)

• whole grains like quinoa (magnesium, B vitamins, fiber)

• dark leafy vegetables like spinach, collard greens, bok choy and kale (vitamin E, fibre and calcium)

• walnuts, pecans and legumes, including peanuts  (vitamin E, fiber and magnesium)

“While supplements are necessary in special cases where nutrients are not being absorbed properly, whole foods are always the recommended first choice,” said Vandana Gujadhur, a registered dietitian at Medcan.

Vitamin B12 deficiencies should be addressed for long-term brain health

The scale’s researchers spoke to the vitamin B12 deficiency common among vegetarians and vegans. Vitamin B12 was highlighted as a brain essential nutrient and can be found in eggs, milk, cheese, meat, fish, shellfish and poultry, as well as some supplements and fortified soy and rice products.

“It is possible to have normal blood B12 levels with a well balanced vegan or vegetarian diet. More and more products are now being fortified with vitamin B12, which makes it easier to stick to a plant-based lifestyle,” said Gujadhur.

For those considering introducing more meat and fish into their diet, the brain food scale promoted the brain boosting properties in animal products such as organ meats and game meats; bivalves (mussels, clams, oysters); mollusks (octopus, squid, snail) and fish (salmon and sardines) – noting to avoid seafood with high mercury content, and the preference for grain-fed beef.

Lack of nutrient-rich foods linked with brain shrinkage

Foods that rank low on this scale include processed foods with high sugar content, refined carbohydrates, and foods with dyes, preservatives, and trans fats. One of the studies supporting the brain food scale looked at dietary patterns and brain size.

A bigger brain has more brain cells, and around 40 to 45 years, our brains begin to shrink. This 2015 study  found people who avoided foods low in brain essential nutrients (and chose colourful plants, seafood and whole grains) had bigger brains at age of 60 to 65. And, their brains shrank at a slower rate.

“This new research adds more validity to the food therapy movement,” says Gujadhur. “It’s exciting to know that more and more people are realizing there’s so much power on our plates.”

Children and devices: when to rein it in

Loss of control is the hallmark of an addiction

By Tania Haas

From zoned-out toddlers to teens with texting tunnel vision, parents of the touch-screen generation can be uncertain on where to draw the line on mobile device usage. While we know a tech-savvy kid is learning skills for the modern world, parents are also aware there are drawbacks with too much device time. Here are ways parents can guide reasonable responses to technology:

Set a limit on recreational screen time

According to the Canadian Society for Exercise Physiology (CSEP), toddlers and children (age 4 and under) should limit screen time to less than one hour a day.  Older children (age 5 to 11) and youth (age 12 to 17) should limit recreational screen time to a maximum of two hours a day. That means less than 120 minutes of cumulative Netflix, texting or playing on the Xbox.

Alternative approaches to media consumption

Screen Time author Lisa Guernsey offers an alternative approach to media consumption. It involves three C’s: content, context, and your child. Guernsey encourages parents to ask: Do you think the content is appropriate? Is screen time a relatively small part of your child’s interaction with you and the real world? Based on these answers, create customized rules for your child.

Say your child is interested in coding or graphic design. This child may have a lot more recreational screen time than other children.

While removing the iPad may trigger tantrums in both toddlers and teens (Canada’s ParticipACTION found that only 24% of 5 to 17 year olds met the recommendation of no more than 2 hours a day), abiding by these guidelines makes space for different types of activity, and better sleeps.

Remove screens from bedrooms, rein in during study sessions

A 2015 study in Pediatrics found that children who sleep near a small screen get an average of 21 fewer minutes of sleep than kids without gadgets in their rooms. In recent decades children’s sleep has decreased by about 30 to 60 minutes –  possibly due to heart-pumping activity being replaced by sedentary screen time. Meanwhile teenagers’ ability to concentrate has reduced.  A Stanford University study linked teenagers’ multitasking computer habits with the loss of the ability to focus.

Choose appropriate games and programs for toddlers

“I know some parents removed screens entirely after seeing their children repeatedly go into a trance-like state. Depending on the design of the program, the images may be too complex for the child to absorb,” says Chantal Wiggins-McKinnon, a registered nurse and Program Lead, Child and Youth at Medcan. “That being said, research shows that more appropriate educational games are benefiting children in ways we couldn’t have expected.”

In general, Wiggins-McKinnon encourages sticking to the CESP guidelines.

Recognize the benefits of social media for older children and teens

The role of technology changes for older children and teenagers. That’s when the digital device is no longer just entertainment or education, it’s a window to the outside world.

“The touchscreen is the conduit for social media, which has been linked to improved friendships among teens, while texting has even been linked to the emotional well-being of teenagers, especially introverted ones,” says Mark J. Rothman, PsyD, CPsych, Registered Psychologist at Medcan.

Watch out for overuse, addiction, warning signs

“The hallmark of an addiction is loss of control,” says Dr. Rothman. “Social media and texting are set up like video games. They are designed to be incredibly self reinforcing.”

While most teens are not addicted, Dr. Rothman says, if not controlled early on, their overuse can harm other aspects of their lives.

Warning signs include slipping grades, hostility, highly sensitivity, strong preoccupation with the phone and not being interested in formerly enjoyed activities.

“The more it starts to invade other relationships or responsibilities; it’s no longer a positive activity,” says Dr. Rothman. “It’s no different than any other privilege or activity that has become an obstacle.”

Prevent compulsive device use

Teens can be reminded that true freedom is the ability to choose. Here are some suggested guidelines:

• Parents and teen agree on set rules before the device is handed over.

• The device should be surrendered when agreements have been broken or there’s been inappropriate usage.

• Limit daily recreational screen time to 1.5 hours ideally (maximum: two hours) or weekends only.

• Establish screen-free times and zones such as no phones in the bedroom at night or at family meals (some parents collect phones ahead of meals or bedtime).

• Encourage mono-tasking or “interval training” away from devices by shutting phones off during homework or other activities.

• Parents can model ideal device behaviour, especially in the car. Reminder: drivers using a mobile device are just as or more dangerous than drunk drivers.

• Download a free usage tracker to the device to monitor daily screen time.

 Teach each other well

“Social media is to teens today, what the telephone was to my generation. Every older generation initially rejects the interests of the next – it’s understandable but not mandatory,” says Dr. Rothman. “Parents and teens can learn together how to wisely use media and technology.”

Best practices of the mindful employer

These strategies help employees thrive

Photo by Brooke Cagle on Unsplash

On April 4, two members of Medcan were panelists at the workplace mental health series hosted by Healthy Minds Canada at Telus House in Toronto.

Dr. Gina Di Giulio, Director of Psychology and Janet Ozembloski, Vice President, Legal and Privacy Officer offered suggestions and strategies for organizations on how to be mindful employers.

They both addressed a certain ‘unknowingness’ that may stop well-intended leaders from approaching and addressing important matters related to mental health. With the right approach, they said, organizations and their leaders can help employees thrive.

Early and appropriate intervention is encouraged

Dr. Giulio encouraged workplace leaders to consider their strategy for recognizing the early signs of employee burnout, anxiety and depression. An ideal organization, she said, would have champions of mental health.

These champions are able to have functional conversations that are perhaps more difficult for other people in the organization and can familiarize themselves with the signs of burnout, depression and anxiety. Those three conditions, either alone or in combination, will make up over 70% of the applications for short-term disability leaves from work.\

Today’s workplace is like an extended family

Janet Ozembloski spoke to the duty to accommodate.

“We are no longer in an era where people come, do their job and go home. The employer-employee relationship is now like a family. The case law has shown that everything is integrated now. The assumption is that we live in a caring society where there is a duty to accommodate. And the only way you stop accommodating that employee is when you get to the point of undue hardship.”

To see the other panelists’ highlights, click here. There’s also a video of the 60-minute panel discussion found at Healthy Minds Canada.

How should workplaces manage mental health?

Mental health issues, or mental illness? Mental health can be a difficult concept to understand.

Photo by Christina @ wocintechchat.com on Unsplash

If you have an employee who is suffering from the flu, or who is in a wheelchair, their illness is visible and typically easy to accommodate. With the flu, there’s sleep and medication. With a wheelchair, it’s accessibility.

Mental health issues, however, are challenging to recognize, and if you’re not trained as a mental health professional, it can go completely unnoticed—especially in the workplace. Add to that stigmas often associated with mental health issues.

“I think that’s why it’s a difficult conversation, people don’t like to talk about things they don’t understand,” said Janet Ozembloski, Vice President, Legal and Privacy Officer at Medcan. Ozembloski was speaking on a panel organized by Healthy Minds Canada last month, part of its Mindful Employer Series.

“I think senior leaders often bury their heads in the sand,” said Ozembloski. “The private domain and the workplace are no longer disembodied. The employer can no longer cast a blind eye.”

The Mental Health Continuum Model

Twenty per cent of Canadians will deal with a mental illness at some point in their lives, according to the Canadian Mental Health Association. But, just because an employee is suffering from mental health issues, doesn’t mean they have a mental illness.

To help employers understand mental illness in the workplace, the Mental Health Commission of Canada developed a Mental Health Continuum model that illustrates the spectrum of symptoms people exhibit when dealing with mental health issues.

One of the most important things that the continuum model shows is that mental health is not binary.

Credit: Mental Health Commission of Canada

Instead, mental health runs along a continuum with different symptoms depending on the variance of your employee’s health.

The continuum can help you recognize the early warning signs of a mental health issue in an employee, minimize the stigma surrounding it, and provide accommodations before they move further along the spectrum.

Ranging from healthy to ill, the continuum shows the stages in-between that could eventually lead to a mental illness. It’s possible to move both forwards and backwards along this continuum, which is where early recognition can help your employees.

Don’t diagnose, accommodate

Dr. Gina Di Giulio, Director of Psychology with Medcan, who also sat on the panel, cited a Centre for Addiction and Mental Health report that concluded there are 500,000 people in Canada who are not at work due to mental health issues.

“You want to retain your workforce as much as possible. In order to do that, you’re going to have to notice the signs,” said Di Giulio.

Using the continuum is a good place to start, Di Giulio said, but it’s also important to appoint champions of mental health awareness within the organization.

Champions should familiarize themselves with the signs of mental health issues: burnout, signs of depression, or signs of anxiety. They should also have high-emotional intelligence and sensitivity towards others—this means your champions may not always need to be someone in a leadership role.

Loretta Brill, CEO of NX Knowledge Corporation, added that managers shouldn’t be expected to act as a psychologist, only to recognize the signs and offer up support.

“A lot of [leaders in the workplace] are making the assumption that the person has a mental illness before they go and have that conversation,” said Brill. She emphasized to leave that part to a trained mental health professional. Instead, their duty as a leader is to accommodate and ultimately help people be successful at their job.

A step forward for those interested in genetic testing

“An act to prohibit and prevent genetic discrimination is one step closer to law in Canada”

Photo by National Cancer Institute on Unsplash

Written by Jill Davies, MSc, CCGC, Director, Genetics. Edited by Tania Haas

Earlier this month, the Senate passed a bill that will position Canada one step closer to protecting its citizens from genetic discrimination. While it’s not yet law, this is a significant step toward preventive and personalized medicine in our country.

Bill S-201, also known as an act to prohibit and prevent genetic discrimination, allows Canadians to seek specific and broad genetic testing without a breach of privacy or the fear of reprisal from their insurer or employer.

The last G7 country to adopt this law
Today it is legally sound for insurers and/or employers to deny coverage or other goods or services based on the results of an individuals’ private genetic test results.

If passed, Canada would join the other six G7 countries, which already have legislation similar to what Bill S-201 is proposing.

Proposed law supports Canada’s R&D
This bill would also support our country’s growing research and development sector, where pioneering science and technology can thrive when not limited by unreasonable and unethical laws.

Innovation has already taken us so far. As Kerry Gold, a board member of the Huntington Society of B.C., wrote in The Globe and Mail earlier this month, “the issue is a priority because genetic study is transforming health care. The study of the human genome, or genetic sequencing, is a new, exciting and quickly growing frontier in medicine.”

Removes significant barrier
The consequences of the current law have been unfortunate and far reaching .

Many Canadians have chosen not to have genetic testing – even though the results could lead to life-saving screening techniques or surgical interventions.

I am personally aware of women who have decided not to have the BRCA1 and BRCA2 tests. Should a risk be found, they tell me, their insurance company is entitled to request that information, which could negatively impact that woman’s personal insurance rate and possibly those of her close relatives.

Cases where an individual’s insurance was or is at risk of being cancelled because of private genetic test results are well documented in Canada.

Privacy and protection for all
My colleagues and I believe genetic characteristics deserve a place next to race, national or ethnic origin, colour, religion, age , sexual orientation and other distinctions found in the Canadian Human Rights Act.

Genetic discrimination in Canada is real and that’s why the Canadian Association of Genetic Counsellors has been advocating for this bill as since its inception.

Insurer’s perspective 
As technology encourages health-care providers and clinicians to adapt to the evolving environment, so must the insurance industry. But there seems to be some unfounded hesitation to change on the part of insurers.

A CEO of a national insurer association recently wrote a column advocating against Bill S-201. He argued the current law is both fair to Canadians and keeps the price of insurance low and stable. Passing of this new bill, he wrote, would lead to a significant increase in the cost of life and health insurance across the country.

I respectfully disagree. His argument assumes that the current model of Canadian insurance must remain static. One of the advantages of Canada’s slower pace on this matter is that we have the opportunity to learn from sophisticated policies and best practices from the earlier adopters among the G7.

Finally, it may be helpful to remember that both the insurance and health-care industries encourage Canadians to make wise health choices to offset suffering and preventable costs in the long term. I look forward to, and I know my clients do as well, any new options the insurance industry creates.

What’s new, what’s next
While Bill S-201 would impact the way insurers operate, the wording of the bill that passed in April doesn’t explicitly name insurance companies.

The bill must pass through three readings in the House of Commons before final approval.

In the name of fairness, open medicine and scientific innovation, I look forward to that day.

Jill Davies is Director of Genetics at Medcan. She was the first Canadian to have her whole genome sequenced and allowed that data to be made publicly available to researchers online.

Our take: the new promise of plant-based diets

Before you go vegetarian for the greater good, consider the Medcan take on this study out of the University of Oxford

New research published in Proceedings of National Academy of Sciences (PNAS) promises that upping your plant-based food intake will not only make you healthier, but also save lives globally and reduce greenhouse emissions. I asked the Nutrition Team at Medcan for context on this study and what advice they’d give their clients. Here’s what they had to say.

Q: So does this mean I should become a vegetarian?
A: There are few things in nutrition that are completely black and white.
In some cases eating animal products may be the better choice. A lot depends on our farming practices. Still, people who eat less red meat have a lower risk of heart disease, diabetes and colorectal cancer.

Q: If it’s green and from a plant, does that mean I’m making a smart food choice? 
A:  Eating your veggies is a wise habit. But not all veggies are created equal.Plant-based means incorporating fruits, vegetables, whole grains, legumes (beans, peas, lentils), nuts and seeds into our diets. It also means getting more of our protein from non-animal sources such as legumes, soybeans and tofu, nuts, seeds and whole grains.

Also, eating vegetables does not offset nutrient-empty food and drink choices.
Adding vegetables doesn’t clean up a diet filled with refined carbohydrates, it doesn’t negate excess alcohol consumption and it doesn’t erase the impact of excess processed meat.  However, there is no denying that including more vegetables daily is very likely a plus towards improving your health.

Q: I’ve tried other food theme approaches, how can I make this one stick for me?
A: If you decide to make a change, do so gradually and within reason.Consider your current diet and commit to realistic and sustainable changes over time.  For example, shrink your meat portion to 1/4 of your plate or no more than the size of your palm, and load up on vegetables.  Start with at least one vegetarian dinner per week featuring a plant-based protein such as a hearty lentil soup, a vegetarian chili or bean burrito.

References
Springmann, M et al. “Analysis and valuation of the health and climate change cobenefits of dietary change”  Proceedings of National Academy of Sciences. April 12, 2016: 4146–4151, vol. 113 no. 15.

Online seminar recap: Approaching menopause on your terms

Women have a greater number of regulated and recommended management options

On March 23, Dr. Janice Weiss, CCFP, NCMP led Approaching Menopause on Your Terms, a Medcan online seminar.

The seminar covered a wide range of topics including the distinction between menopause and perimenopause, suggested treatment options for common symptoms, and relationship guidance including how to keep the magic alive in the bedroom. Dr. Weiss is passionate about menopause management and has been working with women approaching this stage of life for many years.

The flawed Women’s Health Initiative study was also addressed. This is the study that was prematurely stopped in 2001 when hormone therapy was thought to be harmful and as a result lead to great interest in natural health products and bio-identical hormones.

Here are a few of Dr. Weiss’ reflections on hormones:

• Hormone therapy (HT) is safe. We now know HT can be a very helpful approach when used by the right women, at the right time in their lives and for the right length of time.

• Many natural health products are unregulated. This can lead to serious side effects. Natural health products don’t undergo the same rigorous testing as pharmaceutical grade products.

• There is no evidence that bio-identical hormones are safer than government-approved hormones.  And they are generally not prescribed nor recommended by most mainstream physicians.

Dr. Weiss ended the presentation on a hopeful, encouraging note. She believes that after a turbulent few years of avoiding the use of hormones, the pendulum is now swinging back to a happier middle ground in terms of management options.

“The health-care industry is now armed with more treatment modalities than ever before,” said Dr. Weiss. “Women have a greater number of choices and can now direct their own symptom management under the guidance of informed practitioners.”

Dr. Weiss is certified as a menopause practitioner with the North American Menopause Society.