Should clinics prescribe medicinal cannabis that they also supply? We asked 5 experts

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You can have an online consultation, be prescribed medicinal cannabis, and have it sent directly to your home, in a seamless operation. This one-stop-shop certainly sounds convenient.

But not everyoneโ€™s happy.

Industry observers, doctors and pharmacists call these one-stop-shops โ€œvertical integrationโ€. Thatโ€™s when the person who prescribes medicinal cannabis or the clinic that employs them has a financial relationship with the manufacturer of the product and/or the business that dispenses it.

Critics say itโ€™s where prescribers โ€“ GPs, specialist doctors or nurse practitioners โ€“ can feel pressured to prescribe what will make money for clinics, pharmacies and suppliers. Itโ€™s a system where patients can be prescribed medicinal cannabis, despite good clinical reasons not to. It can also lock in patients to specific products or pharmacies.

So should clinics be allowed to prescribe medicinal cannabis if they have financial links to the supplier or dispenser?

We asked five experts. Five out of five said no.

CC BY-NC

Medicinal cannabis prescriptions have skyrocketed in Australia, mostly for legal but unapproved products we donโ€™t even know work or are safe. In this series, experts tease out whatโ€™s fuelling the rise of medicinal cannabis, the fallout, and what needs to happen next.


Barbara Mintzes, Professor in Pharmaceutical Policy, School of Pharmacy and Charles Perkins Centre, University of Sydney; Betty Chaar, Pharmacist and Professor in Professional Ethics in Pharmacy, University of Sydney; Christine Mary Hallinan, Senior Research Fellow, Department of General Practice and Primary Care, Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne; Christopher Rudge, Lecturer in Law, Sydney Law School, University of Sydney, and Wendy Lipworth, Professor of Bioethics, Macquarie University

This article is republished from The Conversation under a Creative Commons license. Read the original article.

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  • White Bread vs White Pasta โ€“ Which Is Healthier?

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    Our Verdict

    When comparing a white bread to a white pasta, we picked the pasta.

    Why?

    Neither are great for the health! But like for like, the glycemic index of the bread is usually around 150% of the glycemic index for pasta.

    All that said, we heartily recommend going for wholegrain in either case!

    Bonus tip: cooking pasta โ€œal denteโ€, so it is still at least a little firm to the bite, results in a lower GI compared to being boiled to death.

    Bonus bonus tip: letting pasta cool increases resistant starches. You can then reheat the pasta without losing this benefit.

    Please donโ€™t put it in the microwave though; you will make an Italian cry. Instead, simply put it in a colander and pour boiling water over it, and then serve in your usual manner (a good approach if serving it separately is: put it in the serving bowl/dish/pan, drizzle a little extra virgin olive oil and a little cracked black pepper, stir to mix those in, and serve)

    Enjoy!

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  • Can Walking Really Burn Belly Fat? What Science Says

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    Visceral belly fat is harmful and increases risks of heart disease, diabetes, and metabolic issues in general. Can walking get rid of it, or are more extreme measures needed? Science does have the answer:

    Steps for good health

    Contrary to popular belief, you donโ€™t need extreme workouts or diets to lose belly fatโ€”walking can indeed be highly effective.

    Per studies, brisk walking (30โ€“60 minutes, 3โ€“5 times per week) significantly reduces visceral fat and waist circumference. And, shocking nobody, combining walking with healthy eating accelerates results. To be clear, because the video isn’t, that doesn’t mean you have to walk and eat at the same time; just, eat healthily and also walk regularly ๐Ÿ˜‰

    To maximize fat loss from walking:

    • Be consistent (walk most days of the week).
    • Walk briskly (able to talk, but not sing).
    • If practical, include hills to challenge muscles and boost fat burn.
    • Aim for 8,000โ€“10,000 steps a day.

    As for walking vs more targeted things like ab excesses: spot reduction is a mythโ€”ab exercises alone wonโ€™t reduce belly fat, but walking promotes full-body reduction in excess fat.

    Bonus: walking also improves mood, reduces stress, and supports heart health!

    For more on all of this, enjoy:

    Click Here If The Embedded Video Doesnโ€™t Load Automatically!

    Want to learn more?

    You might also like:

    Over-50s Physio: What My 5 Oldest Patients (Average Age 92) Do Right

    Take care!

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  • Chickpeas vs Soybeans โ€“ Which is Healthier?

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    Our Verdict

    When comparing chickpeas to soybeans, we picked the soybeans.

    Why?

    Both are great! But:

    In terms of macros, chickpeas have more than 3x the carbs and only very slightly more fiber, while soybeans have more than 2x the protein. Given the ratio of carbs to fiber in each, soybeans also have the lower glycemic index, so all in all, we’re calling this a win for soybeans.

    In the category of vitamins, chickpeas have more of vitamins A, B3, B5, and B9, while soybeans have more of vitamins B1, B2, B6, C, K, and cholineโ€”another win for soybeans.

    When it comes to minerals, chickpeas have more manganese and zinc, while soybeans have more calcium, copper, iron, magnesium, phosphorus, potassium, and seleniumโ€”meaning soybeans win yet again.

    Two extra things to know:

    • Chickpeas are naturally high in FODMAPs, which can be problematic for a minority of peopleโ€”however, canned chickpeas are not.
    • Soybeans are famously high in phytoestrogens, however, the human body cannot actually use these as estrogen (we are not plants and our physiology is different). This means that on the one hand they won’t help against menopause (aside from the ways in which any nutrient-dense food would help), but on the other, they aren’t a cancer risk, and no, they won’t feminize men/boys in the slightest. You/they would be more at risk from beef and dairy, as the cows have usually been given extra estrogen, and those are animal hormones, not plant hormones.

    All in all, chickpeas are a wonderful food, but soybeans beat them by most nutritional metrics.

    Want to learn more?

    You might like to read:

    Why You Canโ€™t Skimp On Amino Acids โ† soybeans also have a great amino acid profile!

    Enjoy!

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  • How Bitter Is Your Diet?

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    Some people have a “sweet tooth”, others amongst us may be more of a bitter soul. Not like thatโ€”your writer here is a delight in all ways, but does enjoy unsweetened espresso ristretto, strong long-steeped green tea, dark leafy greens, and so forth.

    This has its merits, often because of the high polyphenol content of such foods and drinks:

    But what about in terms of assessing a diet as a whole, rather than individual “superfoods”?

    Bitter is better

    The key idea here is that dietary bitterness (i.e. the average bitterness of your diet, taking into account both quantity and intensity of bitter foods) can be a useful proxy for overall diet quality.

    For example, researchers (Dr. Zinat Mohammadpour et al.) did a study using data from 8,975 adults, and found that people with more bitter foods in their diets generally had healthier, more nutritious eating patterns and diets more closely aligned with dietary guidelines.

    There were many such associations, but some of the top ones included:

    • More bitter diets contained more plant foods: compared with the least bitter diets, the most bitter diets included 30% more vegetables, 34% more fruit, and 36% more wholegrain cereals.
    • They also contained more low-fat dairy: low-fat dairy intake was 57.2% higher in the most bitter dietary group. In this case, that means very good odds of getting in useful nutrients and fermented probiotics, without going over the top on saturated animal fats.
    • Refined grains featured a lot less in them: the most bitter diets contained 18% less refined cereal than the least bitter diets. This is unequivocally good. Whole grains are a good part of a healthy balanced diet; refined grains are not. See for example: Grains: Bread Of Life, Or Cereal Killer?

    Nor was it all about foods:

    • Beverages dominated dietary bitterness: beverages accounted for 87% of total dietary bitterness, compared with 13% for solid foods. In the most bitter dietary group, beverages accounted for 94.6%.
    • Coffee and tea were major contributors: the most bitter diets had 285% higher tea and coffee consumption, along with 6% higher milk consumption.
    • Soft drinks and juices featured a lot less: the most bitter diets contained 16% less soft drink and 10% less juice. This is again a very good thing. See for example Soft Drinks & Your Liver: Sugar vs Sugar-Free Sweeteners and Which Sugars Are Healthier, And Which Are Just The Same? โ† this latter article explains why fruit is generally very healthy, while fruit juice is metabolically bad (even if it contains good nutrients, is hydrating, etc).

    If you don’t love bitter foods, don’t worry: Dr. Mohammadpour and her team emphasized that a diet does not need to contain intensely bitter foods. Increasing the amount of mildly bitter foods, such as salad vegetables and broccoli, can raise overall dietary bitterness. Like we said up top, it’s about the average bitterness of your diet as a whole, not individual superfoods.

    You can read this paper in full, with all its data, here: Bitterness as an indicator of diet quality: A secondary analysis of the Australian National Nutrition and Physical Activity Survey

    Want to learn more?

    For a very healthy polyphenol-laden starter menu, consider:

    21 Most Beneficial Polyphenols & What Foods Have Them

    Enjoy!

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  • Energize! โ€“ by Dr. Michael Breus & Stacey Griffith

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    We previously reviewed another book book by Dr. Breus, The Power Of When. So whatโ€™s different in this one?

    While the chronotypes featured in The Power Of When also feature here (and sufficient explanation is given to make this a fine stand-alone book), this book has a lot to do with metabolism also. By considering a personโ€™s genetically predisposed metabolic rate to be fast, medium, or slow (per being an ectomorph, mesomorph, or endomorph), and then putting that next to oneโ€™s sleep chronotype, we get 12 sub-categories that in this book each get an optimized protocol of sleep, exercise (further divided into: what kind of exercise when), and eating/fasting.

    Which, in effect, amounts to a personalized coaching program for optimized energy!

    The guidance is based on a combination of actual science plus โ€œif this then thatโ€ observation-based principlesโ€”of the kind that could be described as science if they had been studied clinically instead of informally. Dr. Breus is a sleep scientist, by the way, and his co-author Stacey Griffith is a fitness coach. So between the two of them, they have sleep and exercise covered, and the fasting content is very reasonable and entirely consistent with current consensus of good practice.

    The style is very pop-psychology, and very readable, and has a much more upbeat feel than The Power Of When, which seems to be because of Griffithโ€™s presence as a co-author (most of the book is written from a neutral perspective, and some parts have first-person sections by each of the authors, so the style becomes distinct accordingly).

    Bottom line: if youโ€™d like to be more energized but [personal reason why not here] then this book may not fix all your problems, but itโ€™ll almost certainly make a big difference and help you to stop sabotaging things and work with your body rather than against it.

    Click here to check out Energize!, and do just that!

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  • What’s Your Ikigai?

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    Ikigai: A Closer Look

    Weโ€™ve mentioned ikigai from time to time, usually when discussing the characteristics associated with Blue Zone centenarians, for example as number 5 ofโ€ฆ

    The Five Pillars Of Longevity

    Itโ€™s about finding oneโ€™s โ€œpurposeโ€. Not merely a function, but what actually drives you in life. And, if Japanese studies can be extrapolated to the rest of the world, it has a significant and large impact on mortality (other factors being controlled for); not having a sense of ikigai is associated with an approximately 47%* increase in 7-year mortality risk in the categories of cardiovascular disease and external cause mortality:

    Sense of life worth living (ikigai) and mortality in Japan: Ohsaki Study

    *we did a lot of averaging and fuzzy math to get this figure; the link will show you the full stats though!

    In case that huge (n=43,391) study didnโ€™t convince you, hereโ€™s another comparably-sized (n=43,117) one that found similarly, albeit framing the numbers the other way around, i.e. a comparable decrease in mortality risk for having a sense of ikigai:

    Associations of ikigai as a positive psychological factor with all-cause mortality and cause-specific mortality among middle-aged and elderly Japanese people

    This study was even longer (12 years rather than 7), so the fact that it found pretty much the same results the 7-year study we cited just before is quite compelling evidence. Again, multivariate hazard ratios were adjusted for age, BMI, drinking and smoking status, physical activity, sleep duration, education, occupation, marital status, perceived mental stress, and medical historyโ€”so all these things were effectively controlled for statistically.

    Three kinds of ikigai

    There are three principal kinds of ikigai:

    • Social ikigai: for example, a caring role in the family or community, volunteer work, teaching
    • Asocial ikigai: for example, a solitary practice of self-discipline, spirituality, or study without any particular intent to teach others
    • Antisocial ikigai: for example, a strong desire to outlive an enemy, or to harm a person or group that one hates

    You may be thinking: wait, arenโ€™t those last things bad?

    Andโ€ฆ Maybe! But ikigai is not a matter of morality or even about โ€œwarm fuzzy feelingsโ€. The fact is, having a sense of purpose increases longevity regardless of moral implications or niceness.

    Nevertheless, for obvious reasons there is a lot more focus on the first two categories (social and asocial), and of those, especially the first category (social), because on a social level, โ€œwe all do well when we all do wellโ€.

    We exemplified them above, but they can be defined:

    • Social: working for the betterment of society
    • Asocial: working for the betterment of oneself

    Of course, for many people, the same ikigai may cover both of thoseโ€”often somebody who excels at something for its own sake and/but shares it with others to enrich their lives also, for example a teacher, an artist, a scientist, etc.

    For it to cover both, however, requires that both parts of it are genuinely part of their feeling of ikigai, and not merely unintended consequences.

    For example, a piano teacher who loves music in general and the piano in particular, and would gladly spend every waking moment studying/practising/performing, but hates having to teach it, but needs to pay the bills so teaches it anyway, cannot be said to be living any kind of social ikigai there, just asocial. And in fact, if teaching the piano is causing them to not have the time or energy to pursue it for its own sake, they might not even be living any ikigai at all.

    One other thing to watch out for

    There is one last stumbling block, which is that while we can find ikigai, we can also lose it! Examples of this may include:

    • A professional whose job is their ikigai, until they face mandatory retirement or are otherwise unable to continue their work (perhaps due to disability, for example)
    • A parent whose full-time-parent role is their ikigai, until their children leave for school, university, life in general
    • A married person whose โ€œdevoted spouseโ€ role is their ikigai, until their partner dies

    For this reason, people of any age can have a โ€œcrisis of identityโ€ thatโ€™s actually more of a โ€œcrisis of purposeโ€.

    There are two ways of handling this:

    1. Have a back-up ikigai ready! For example, if your profession is your ikigai, maybe you have a hobby waiting in the wings, that you can smoothly jump ship to upon retirement.
    2. Embrace the fluidity of life! Sometimes, things donโ€™t happen the way we expect. Sometimes lifeโ€™s surprises can trip us up; sometimes they can leave us a sobbing wreck. But so long as life continues, there is an opportunity to pick ourselves up and decide where to go from that point. Note that this is not fatalism, by the way, it doesnโ€™t have to be โ€œthis bad thing happened so that we could find this good thing, so really it was a good thing all alongโ€. Rather, it can equally readily be โ€œwell, we absolutely did not want that bad thing to happen, but since it did, now we shall take it this way from hereโ€.

    For more on developing/maintaining psychological resilience in the face of lifeโ€™s less welcome adversities, see:

    Psychological Resilience Training

    โ€ฆand:

    Putting The Abs Into Absurdity โ† do not underestimate the power of this one

    Take care!

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