More in Writings
A friend recently drew my attention to the fact that Season 16 of Grey’s Anatomy seemed different. I have to admit, I didn’t realize Grey’s Anatomy was still on air. Is that bad?
The difference this season is that Meredith Grey, the main character, is stirring things up. She falsified insurance documents so that one of her patients could receive the medical treatment that they otherwise would not have been able to afford. She was fired from her job and her medical license went under review. During her work in community service, she realizes that the current health care system leaves many people behind. She is becoming more aware of the social determinants of health.
The social determinants of health are those things that determine one’s health from a social point of view. Those who are poor or racialized, for example, often have worse health outcomes than those who are not. I’m currently working in Yellowknife where I am seeing this first-hand. Canada’s history of racism against Indigenous peoples has resulted in social, economic and cultural marginalization. This has a direct impact on their health.
Grey’s Anatomy is scratching the surface of this issue. And they don’t go far enough. Much can be said from the language they use. I notice Meredith uses the phrase ‘institutional discrimination’ rather than systemic racism, which is more accurate.
The irony in Grey’s Anatomy is that Meredith Grey is fired from her job for caring about her patients. As healthcare professionals, we can feel silenced in our desires to conduct advocacy work. We may feel pressure from the institutions that we work for or our professional or governing associations. We may fear losing our jobs and our security, or even damaging our reputations. But the work of advocacy is so important. It is this work that can make an even greater difference than prescribing a medication.
Overall, I’m impressed with Grey’s Anatomy for at least starting the conversation.
Why relationships in primary care matter now more than ever (hint: virtual health care isn’t everything)
This guest blog, by Dr. Arundhati Dhara, was re-published with permission from the Nova Scotia Health Ethics Network
Does virtual care really work?
To state the obvious, COVID has been hard for everyone. For health care providers, there is a sense of discombobulation. We are experiencing the same anxiety and depression as other Nova Scotians, while also trying to help our patients address their mental health and wellness. We are treating those with COVID 19 and those without it with many of the same precautions. It is an enormous effort. At the same time, we are dealing with the sensation that our own lives – both professional and personal – are barely hanging on by a thread as we wait for the other shoe to drop. We have not addressed the blurring of the personal and the professional, the fears of bringing home COVID 19 to our families, and the guilt that comes from that fear. We need an honest conversation that acknowledges how messy (and even impossible) it has been to actually heal people during a pandemic.
I read somewhere that COVID is the Great Exacerbator. This moniker applies just as much to health care providers as it does for the patients we care for. Early in the pandemic, Nova Scotia moved most of the delivery of primary care away from in-person visits towards telephone calls, and then to virtual platforms. On the face of it, this represents the very best of what we can do – responding quickly, being nimble and flexible while continuing to provide good care to patients. We congratulated ourselves on our ingenuity and ‘seamless’ care transitions. But the unexpected consequence was that we further downgraded the relational work of family medicine at a critical moment.
Initially patients got their prescriptions refilled, their children attended to, and their fears about the novel coronavirus allayed. Phone visits were able to meet some basic health care needs. By this I mean that defined problems with defined solutions were well suited to virtual care. But as the pandemic has gone on (and on and on), the cracks in our new model are starting to show for patients and providers alike. This is especially true in domains like mental health where the problems are more nuanced and the solutions complex. It will come as no surprise that COVID has taken a profound toll on the mental health of Nova Scotians. While Nova Scotia has seen some of the lowest rates of COVID 19 in the country, we are not immune to the suffering. Paradoxically, depression and anxiety rates (due to the pandemic) are higher here than anywhere in the country (https://researchns.ca/2020/10/01/mhrc-release/).
Why relationships matter
COVID 19 and the mostly necessary move to virtual visits highlights how little we value the real work of healing in medicine. Family doctors will often talk about the ways that we ‘walk with our patients’ through their lives and experiences. Zoom calls do not allow us to do that. In fact, for many patients, internet availability or unreliable access to phones or mobile phone minutes means that it is hard to even attend such an appointment. And even for those whose internet connections are stable, “Zoom fatigue” is real, to the detriment of us all.
Health and wellness are not linear and caring for patients requires a great deal of finesse. Providing effective care during COVID depends on the relational work of family medicine, especially to mitigate the mental health effects of the pandemic. The relationships between family physicians and their patients are a form of social capital from which we have been drawing throughout the pandemic. These investments allow us to offer care over the telephone for patients we know well, but it is near impossible to build anything new.
We’ve been getting by with virtual care, and during the pandemic, it may be the best option possible given the many constraints we are facing. But we need to recognize and value the relational effort that makes virtual care function. Ultimately, family medicine is built on relationships. It is relationships, in the clinic and in our communities that will get us through this pandemic.
One of the silver linings of the pandemic is that it has forced the rapid advancement of technology. Not only does this apply to virtual care, but academic conferences have also moved into the virtual sphere. Today, my colleagues and I presented our research at the International Conference on Communication in Healthcare in Vienna (a.k.a. from the comfort of my Canadian living room). We examined Singapore’s use of digital communication during the COVID-19 pandemic.
One of our most interesting findings was with respect to an app used by Singapore’s government called Trace Together. This voluntary app uses Bluetooth technology for contact tracing. Interestingly, Canada is moving forward with a very similar initiative.
Problems with the Trace Together app
Since rolling out the app in Singapore, there have been various issues. One complaint is that the app eats up the battery life of the user’s phone. You need to have the app open in order for it to function, and when it is open, you can’t have other apps running at the same time. Also, not everyone trusts that the app respects privacy.
Maybe this is why less than half of the population of Singapore have downloaded the app to date. In order for such an app to be effective, uptake would need to be at least 75% according to Singapore’s National Development Minister Lawrence Wong. Dr. Theresa Tam, Canada’s Chief Public Officer of Health, said that it is possible that a lower uptake rate could be effective during a press briefing on September 1. She emphasized the potential benefit the app could have with respect to Canada’s younger demographic who are more likely to visit restaurants and pubs.
Information seems to changing daily and it is hard to truly know how effective this technology will be. We do know that Singapore is now moving to wearable bracelets for contact tracing rather than relying solely on the app.
As Canada adopts a very similar technology for contact tracing, we should look to Singapore for important lessons and cautions.
Are you willing to download a contact tracing app on your phone?
I’m curious. Let me know in the comments below!
Sexism in Medicine
In a clear example of sexism in medicine, the study went so far as to create false social media accounts to ‘creep’ vascular surgery residents’ social media profiles. Of note, all of the individuals who created the accounts, and most of the authors on the paper, were male. This was all done without the residents’ knowledge or consent. The study concluded by criticizing vascular surgery trainees for being too unprofessional on social media.
One of the numerous problems with this research was the authors’ definition of what constitutes unprofessional behavior. They deemed that it was unprofessional for women to share photos of themselves in 👙 bikinis or “provocative Halloween costumes” on their personal social media accounts.
The research ironically had an unintended side effect: since the publication of this paper, there has been a major backlash. So much, in fact, that the authors apologized and the Journal retracted the paper. Since Friday, women doctors have been taking to social media platforms like Twitter and using the hashtag #medbikini, posting photos of themselves in bikinis to protest the idea that wearing a bikini constitutes unprofessional behaviour. The study exposed some of the serious gender biases that are all-too prevalent in medicine.
Did you know that over half of my medical school class was comprised of women? Whether it’s medicine, engineering or stock trading women are increasingly occupying positions traditionally held by men. As these changes occur, we must closely monitor and advocate against sexism within the system.
Professionalism in Medicine
As doctors, whether male or female, we are encouraged to completely detach our personal lives, and even our personalities, from our role as a doctor.Could this be doing more harm than good?
I’ve always thought it was unfair that I have immediate access to my patients’ complete medical files while they usually know next to nothing about me. I know details about their last pregnancy, their recent mental health struggles, even about their food intolerances. Yet us doctors are supposed to remain mysterious and neutral. Caring but aloof. We are expected to refrain from divulging too much about ourselves. Would patients not feel more comfortable if we opened up a bit more, and if sharing was more like a two-way street? A study from 2017 actually found that sharing online biographies about physicians could help reduce communication apprehension among patients.
Doctors as Health Advocates
Another major issue with the paper is that it argued that it is unprofessional for doctors to discuss controversial political issues on social media. This runs contrary to the recommendations of many professional guiding bodies. If you examine the core competencies of being a physician, as outlined by the Royal College of Physicians and Surgeons of Canada, we should be serving as health advocates. Instead of encouraging such advocacy, the above-mentioned article considered the vascular surgery residents as acting unprofessionally if they discussed issues like gun control or abortion on their social medial platforms.
Discussing taboo issues is necessary for progress in society. Doctors deserve the right to weigh in on controversial issues just as much as anyone else. And maybe now and again we can also share an image of ourselves being regular humans and having fun in (gasp!) a bikini 🙂
Reducing sexism in medicine and reexamining professionalism in medicine is how we move forward.
Thoughts? Let me know in the comments below!
This week, I opened my planner and came across a list of my goals for Spring that I’d written back in early January: attend a Latin dance festival; get my blue belt in Brazilian Jiu Jitsu; travel. These sorts of activities open my mind, allowing me to make progress in areas of my life outside of medicine. Maybe that list was a tad ambitious at the concept stage, for my plans also included attending conferences and meetings across Canada while still pursuing my Master’s in Journalism part-time and continuing my work as a physician. (How can I forget?)
Needless to say, my plans for 2020 have changed. The world looks a lot different now. Life as we know it will be punctuated by the pandemic; we will have pre-COVID and post-COVID eras. I’m wondering how this post-COVID era will evolve.
Instead of pursuing my perfect plans, I’m learning as much as I can about a disease that didn’t previously exist while trying to stay healthy and balanced. I’ve moved back home to Nova Scotia. Working as a doctor and reading about COVID-19 takes up a substantial portion of my time. While my patients in the hospital aren’t allowed to have visitors during the pandemic, I’m also grappling with my own lack of human contact outside of work. I won’t be able to see my nieces and nephews for an unknown length of time. My social scene has shrivelled. I linger longer at the hospital than I need to, conversing with colleagues two metres apart through masks, knowing that I won’t see anyone in person again until my next shift. And in what universe is dating possible? These changes aren’t easy.
A friend of mine described the pandemic as “bittersweet” after having spent the day at home hunting for Easter eggs with his children. Bittersweet Symphony by The Verve has always been one of my favourite songs. The song is more relevant now than ever. I tend to ebb and flow between the bitter and the sweet anyway. The pandemic has only amplified these states of being. I’m bitter for a few reasons: Dancing while physical distancing doesn’t work; digital jiu jitsu isn’t the same; Facetime can never replace being with friends and family. I am hoping for a sweetness, though, in the emergence of new patterns. Especially simplicity.
When I began preparing my lunch today, I looked at my cupboard. At first glance, I didn’t think I had many options. Pre-COVID, I would have hopped in my car and made a trip to the grocery store to replenish my seemingly scarce supply. But today, in the age of staying put, I ate what I already had on hand. Beans, a slice of bread and two eggs. It took me five minutes to make lunch (and it tasted pretty darn good). I’m talking to old friends on the phone almost everyday. I’m reading more books and listening to more music. Despite the global chaos, my life is becoming more simple.
As someone who is always ‘on the go,’ the pandemic has given me the gift of reflection. In slowing down, I’m defining the values that I really want to nurture, sketching out my life as I want it in a post-COVID world. My revised list of goals for 2020: Enjoy life; keep it simple; be in love; don’t make lists; when getting the urge to make a list, fight the urge and revert to the first item on the new list – enjoy life.
Having recently returned from the U.S., I’ve now finished my 14 days of self-isolation. Now, it’s back to work in the hospital. Over the last two weeks, I had very little sunshine. All of my food was delivered. The most difficult part of all, though, was that I missed having human contact.
Self-isolation was hard. Really hard. Yesterday, I waited by my window so I wouldn’t miss the moment when the food delivery guy dropped off my burger and salad, just so I could see another person, even if it was only for a few seconds. We waved to each other through the glass, offering a reciprocal half smile. A moment of recognition that we are in this together.
I’ve also been doing some activities that are perhaps less reflective. I started using the social media platform TikTok, taking a particular interest in the #boredinthehouse challenge. People from all around the world make funny videos of themselves bored in their houses to the tune of the same song. The lyrics are: Bored in the house and I’m in the house bored. Repeated. Ironically, watching these videos has been extremely entertaining. I made my own #boredinthehouse video, too.
As far as Netflix is concerned, I’m on Season 3 of This is Us. I can’t tell whether I’m crying because Kevin and Zoe might break up (he wants kids and she doesn’t) or if it’s because the world as I know it has flipped upside down. Both? It ‘s strange to be switching between using technology for entertainment then using it for webinars with other doctors from across the province about pandemic preparedness.
You may not think that following self-isolation strictly is a big deal, but it is. Self-isolation is important, even if you’re young and healthy.
|Which Nova Scotians need to self-isolate?|
|If you’ve travelled outside of Canada|
|If you’ve travelled outside of Nova Scotia|
|If you’ve been diagnosed with COVID-19|
|If you have symptoms and you’re waiting for your COVID-19 test results to come back|
|If you’re in close contact with someone who has been diagnosed with COVID-19|
Let’s take Jane Doe as an example. Jane is a 38-year-old woman who recently returned from Florida. At the airport, she’s instructed to self-isolate for 14 days. Her friend invited her over for dinner, and since it was just one friend, and Jane didn’t have symptoms, Jane thought it would be ok to go.
Though Jane had no symptoms, she incorrectly assumed she didn’t have the infection. According to the Public Health Agency of Canada, those with COVID-19 may have little to no symptoms. Also, people without symptoms can still pass on the virus.
The time between exposure to the virus and developing symptoms is called the incubation period. For COVID-19, it appears that the incubation period is between 5 and 14 days, according to a study published in March. That’s why self-isolation is needed for 14 days after traveling. If you have no symptoms after Day 14, you likely don’t have an active infection. But just because you’ve finished self-isolation, it doesn’t mean you’re off the hook. The physical distancing rule still applies. You could still get an infection and pass it on to others.
Back to Jane. A few days after Jane arrives back from the U.S., she develops a fever and a dry cough. Her friend becomes ill, too. Not only has Jane passed on COVID-19 to her friend, but her friend has infected three people. Each of those people have infected three more. You don’t have to be a mathematician to realize the potential impact. The growth is exponential.
Jane also didn’t realize that younger people could end up in the hospital. According to the Public Health Agency of Canada, approximately 12% of people hospitalized with COVID-19 were under the age of 40. (An earlier figure was estimated at 30%, but this has since been corrected).
Fast forward two weeks. Let’s say a few other people fail to take self-isolation seriously. Those of us working in the hospital (including me) now have a lot of extra patients with COVID-19. We’ll feel burnt out more easily if we are over capacity. Plus, the more people admitted with COVID-19, the easier it will be for doctors and nurses to catch it. If we catch it, we would then need to self-isolate and be away from work for two weeks.
By staying at home, not only are you protecting healthcare workers, but you are also protecting your friends and family. You are protecting your grandmother, who would be more likely to suffer serious consequences from getting sick due to her age. You are protecting your neighbour who has a suppressed immune system due to her diabetes. We really are all in this together. The actions of one individual can determine the outcome for an entire community. As Canadian Prime Minister Justin Trudeau said in a recent press briefing, “Go home and stay home.”
I really don’t want to get sick and have to self-isolate again. It was fun exploring TikTok and making that #boredintheouse video. But if I have to self-isolate again, I’ll probably make another one. Don’t you think my time is better spent taking care of you?
The number of COVID-19 cases now exceeds 378,000 worldwide. This new coronavirus, also known as SARS-CoV-2, is having unprecedented global effects. The number of deaths in Italy surpasses 6000 and there is a lock-down in many countries. The number of worldwide cases of COVID-19 increases each day and it is important we do everything we can to prevent the spread of disease. To achieve this, we need to understand how the virus works. Fortunately, we have research.
To understand the research on COVID-19, it helps to know that there are different types of coronaviruses. The SARS virus was a coronavirus. The common cold can be caused by a coronavirus, too. You can think of these other types of coronaviruses as cousins to COVID-19. In February, a group of researchers studied how long these cousins of COVID-19 remained on different surfaces. They reviewed 22 studies and found that other coronaviruses could live on surfaces for up to nine days. They also found that coronaviruses remain longer on plastic and metal.
Another study published in March compared how long COVID-19 remained active on different surfaces. They found that COVID-19 can live up to three days on plastic and on stainless steel. It can live on cardboard for up to 24 hours and on copper for up to four hours.
It’s important to be aware that even if you are practicing safe physical distancing from others, the virus could be present on surfaces nearby. If you touch a surface that has not recently been cleaned, you could be at risk of getting the infection. That’s why it is important to maintain clean surfaces, wash your hands frequently and avoid touching your face. Interestingly, a study from 2015 found that people touch their face on average 23 times per hour.
What you can do:
- The coronavirus can stay active on surfaces for days. Clean and disinfect surfaces frequently, especially high touch surfaces like door knobs, light switches, countertops, phones, keyboards, faucets and toilets.
- Wash your hands for at least 20 seconds or use hand sanitizer. Avoid touching your face.
- Listen to public health officials.
- If you stay at home, you will save lives.
The Government of Nova Scotia has declared a provincial state of emergency. Today at a press briefing, Premier Steve MacNeil, Chief Medical Officer Dr. Robert Strang other top officials updated the public on the latest restrictions. Tighter measures were put in place after some Nova Scotians were not taking social distancing seriously enough. Here are the highlights of the recent changes:
- No more gatherings in groups greater than five people
- Continued social distancing, stay at least two metres apart from each other
- All public parks are closed. Anyone in a public park will be considered to be trespassing.
- Police officers can now enforce social distancing and self-isolation
- Mandatory 14-day self-isolation for anyone coming in to Nova Scotia, even if coming in from another part of Canada
- Dentist offices are closed unless it is an emergency
- New fines introduced: If individuals are found to violate the above measures they will be fined $1000. Businesses will be fined $7500. Fines can be given on multiple days.
In the next 1-2 days, Nova Scotia will double its COVID-19 testing capacity. We will no longer need to send tests out of the province to be verified.
Dr. Strang also emphasized that though physical restrictions are tightening, we still need to support each other as a community.
I couldn’t agree more with doing everything possible to flatten the curve. It is great to see so many people listening to their public health officials. Let’s get everyone on board.
In the time of COVID-19, a week feels more like an eternity. I find myself checking the news hourly just to keep up-to-date. This week, the World Health Organization officially named the COVID-19 outbreak as a pandemic. U.S. President Donald Trump has banned incoming flights from 26 European countries. The wife of Canadian Prime Minister Justin Trudeau, Sophie Gregoire-Trudeau, confirmed that she tested positive for COVID-19 today. Both individuals are in isolation.
With these developments and certainly more to come, there is a heightened focus on what we can be doing as a society to protect ourselves and each other.
Flattening the curve
It is a concept that has become increasingly talked about, especially in recent days. Flattening the curve is a method that can be used to ease pressures on the health care system during pandemics. Have a look at this graph:
The x axis (or horizontal axis) represents time. The y axis (or vertical axis) represents number of cases. In the case of COVID-19, if no public health interventions are put in place, we would expect the results of the yellow curve. There would be an exponential number of new COVID-19 cases over a shorter period of time. In health systems already pressured and operating at their maximum capacity (which is true of many health care systems in our world), a pandemic would create extra strain. It may lead to a scenario were there are not enough resources to treat everyone.
The blue curve represents what would happen if appropriate public health measures are followed. This includes policies like implementing social distancing and increasing public education. We are already seeing many measures such as this take place across Canada. The government of British Columbia requires the cancellation of all gatherings of 250 people or more. All publicly funded schools in Ontario will close for two extra weeks after March break.
Numerous professional sports leagues have suspended their seasons, including the NBA, NFL and MLB. Many governments are discouraging travel, or in some cases, prohibiting it. There is extensive public messaging around hand hygiene and cough hygiene. Alternatives to handshakes are being promoted.
The COVID-19 pandemic is overwhelming systems, even in countries that are well-resourced. Dr. Giacomo Grasselli is a senior Italian government health official coordinating the network of Intensive Care Units in Lombardi, Italy. In an interview with Channel 4 News, he described the severity of the pandemic in his region, which is the worst affected area in Italy.
“It’s worse than a bomb because a bomb is one event limited in time and space. This is an event that…keeps increasing and it’s contagious.”
Dr. Graselli added that he never thought he would be in a situation where he would have had to create 500 new ICU beds over a two-week period.
“If you are not very careful in controlling the spread of the disease, this disease will overwhelm your system, not matter how efficient, good, modern it is.”
Panic is never a helpful emotion, no matter what the situation. It will certainly not help in addressing the pandemic. For example, if an asymptomatic person goes to a testing centre or emergency department against government recommendations, they are unnecessarily putting themselves at risk. They are also contributing to strain on the system, preventing others from getting the care they need.
That being said, rational thinking and preparedness are essential. I think this pandemic presents another natural experimental question: Will society listen to scientists and follow governmental recommendations? I hope that the answer is yes.
When I was in my early twenties, I followed a vegan diet for several years. As a graduate student in Environmental Sciences in Montreal, several of my classmates and friends were vegan. There were a number of high-quality vegan restaurants nearby and the local grocery stores had sizable health food sections. Surrounded by other vegans and living in a city with plenty of food options, it wasn’t too challenging to stick to vegan eating.
A few years later, when I started working and traveling more often, being a vegan wasn’t so easy. I didn’t have the time to devote to it to make sure I was getting the proper nutrition. When traveling, eating healthy can be challenging at the best of times. For me, remaining a vegan while traveling meant resorting to fries or salads with soggy lettuce and tomatoes.
It was at this time when I decided to introduce animal products into my life again. Once I did so, I felt I had more energy. Being an omnivore again, I didn’t have to plan my meals as much. At the time, I felt healthier. It was easier, too.
Since my days as a vegan, I’ve completed medical school and I’ve been practicing as a physician for over three years now. With my work in the hospital, often the patients I see are very sick. I care for people with complications arising from conditions such as diabetes, heart disease and obesity. While this work is important and crucial, it also makes me reflect on another important topic: preventative medicine.
We know that proper diet and exercise are necessary for the prevention of disease. Yet in medical school, these elements are almost completely lacking in most curricula. The field of medicine is disproportionately focused on the medical management of disease after is has occurred. I frequently find myself lacking both the knowledge and time to discuss with my patients the importance of disease prevention.
Since med school didn’t do this topic justice, this year I am taking the time to teach myself as much as I can about nutrition and exercise. The first of which is exploring the ever-popular topic of veganism.
Despite the lack of nutrition education in med school, the academic world is focusing more on this topic. The graph below, published in a study from 2019 (1), shows that in the last ten years, there has been a large increase in the number of studies about veganism and plant-based nutrition.
Systematic reviews are large studies that aim to review all of the research related to a given topic, combining the results of multiple studies over long periods of time. In a systematic review from 2018 (2), the authors found that when compared with omnivores, vegans had a lower body mass index, lower blood pressure and lower waist circumference. In 2018, the American Medical Association advocated that hospitals should offer more vegan meal options. The company Beyond Meat, which produces products like plant-based burgers, has been making waves in the stock market. Veganism has become mainstream.
Nearing the end of 2019, it was a good time of year to explore something old, yet new. What would happen if I tried to be a vegan again? I decided to do a week-long trial. If you want to see my video log of the experience, you can find it here on my InstagramTV.
Previously, when I was a vegan, I did it for several reasons – to lessen my environmental footprint, to stay healthy and because I didn’t like how animals may be treated in factory farms. It was a combination of these same reasons that made me want to pursue veganism again.
Overall, it was a great week, but it definitely presented some challenges. Sometimes I would order food at a restaurant, only to realize that I forgot to ask to hold the cheese. Then, once it was on my plate – well – who can say no to cheese? Vegans I guess! But in that moment, I could not. Another time, after eating some dark chocolate, I read on the ingredient list afterwards: may contain milk products. On another occasion, I caved for a muffin (it was delicious).
I ate mostly vegan for the week, but I definitely realized that I fell into the category of cheagan (cheating vegan).
On days when I was really busy, and didn’t plan properly, I didn’t get enough protein. During these days, my brain felt foggy and I felt more tired than usual. But on the days when I carefully planned my meals and paid attention to what I was eating, I felt light and like a I had lots of energy.
Part of my vegan trial included traveling from the U.S. to Canada. There were a surprising number of vegan options at the airport. Traveling as a vegan isn’t as challenging as it used to be.
A tip that some of my followers on Instagram suggested was that is doesn’t have to be all or nothing. Some people live a mostly vegan lifestyle but then take days when they eat non-vegan. Others will follow a vegan diet for a few weeks, or even one day a week. Some nutrients that are easy to miss in a vegan diet are B12, iron and calcium.
So. Am I ready to run full throttle into the vegan life? No. But being vegan for a week gave me a kick start of incorporating more plants into my diet. Since then, I’ve managed to keep off five extra pounds, and I’m feeling better overall. Have you ever tried being a vegan? Let me know in the comments below!
- Medawar, E., Huhn, S., Villringer, A. et al. 2019. The effects of plant-based diets on the body and the brain: a systematic review. Transl Psychiatry 9, 226.
- Benatar, J. R. & Stewart, R. A. H. 2018. Cardiometabolic risk factors in vegans: a meta-analysis of observational studies. PLoS ONE 13, e0209086