CEimpact Podcast

Can the Food We Eat be Medicine?

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This podcast explores the evolving role of pharmacists in the "food as medicine" movement, highlighting how nutrition can complement medication therapies in disease prevention and management. Learn practical strategies for counseling patients on nutrition and navigating medication-nutrient interactions to optimize therapeutic outcomes. Stay ahead of the curve—tune in and enhance your pharmacy practice by incorporating food-based interventions into patient care.

HOST
Joshua Davis Kinsey, PharmD
VP, Education
CEimpact

GUEST
Marry Vuong, PharmD, BCPPS
Chief of Staff
Perfecting Peds

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CPE INFORMATION
Learning Objectives
Upon successful completion of this knowledge-based activity, participants should be able to:
1. Identify key nutritional strategies that complement medication therapies in the prevention and management of chronic diseases.
2. Explain common medication-nutrient interactions and their implications for patient care in pharmacy practice.

0.05 CEU/0.5 Hr
UAN: 0107-0000-24-271-H01-P
Initial release date: 11/11/2024
Expiration date: 11/11/2025
Additional CPE details can be found here.

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Speaker 1:

Hey, ce Plan members From CE Impact, this is Game Changers. I'm Jen Moulton, president and Founder of CE Impact. If you're an avid listener, you know I've served as your host for quite some time now and the time has come to pass the reins to one of our very capable and gifted pharmacists, josh Kinsey. Dr Kinsey has been with CE Impact for more than three years now and is the mastermind behind our course content and curriculum. I'm so excited he's agreed to host the podcast because I think you are all going to learn so much from him and from all of our guests. But before I pass the torch to Josh, I wanted to get in a shameless plug for subscribing to Pharmacist by Design if you don't already. You can get CE for this podcast plus so much more for less than $10 a month. You're already listening, so there's no reason not to claim CE credit for learning. Check out the link in the show notes or go to ceimpactcom to enroll. Okay, back to the episode. Take it away, my friend.

Speaker 2:

Hey, ce Impact subscribers, Welcome to the Game Changers Clinical Conversations podcast. I'm your host, josh Kinsey, and I'm really excited about our conversation today. In this episode, we'll explore the growing role of nutrition and pharmacy practice, focusing on how food can complement medications and managing chronic diseases. We'll discuss opportunities for pharmacistsists, as well as some of the challenges and practical steps needed to make this shift in pharmacy practice. I can't wait to learn more about enhancing therapeutic outcomes by embracing food as medicine, as this topic is extremely interesting to me, and with that I'd love to introduce our guest. It's so great to have Mary Wong with us today to dig into this topic and share more about this fascinating world of food as medicine, so it's so good to have you, mary. Thanks for joining us today.

Speaker 3:

Thank you so much for having me. Honestly, food as medicine is like one of my favorite topics and if you're ever like on a call with me with patients, you already know that I'm going to bring out all of the different recipes and things that they can use to treat their kids. So thank you so much for having me.

Speaker 2:

Yeah, that's amazing, so good. So, mary, for our learners, if you want to take just a minute or so and tell us a little bit about yourself and you've already said, of course, that you are passionate about this topic, but maybe where did that come from? What makes you so passionate about the topic?

Speaker 3:

Okay, so my name is Mary Vong. I am a board-certified pediatric pharmacist who worked in the hospital for about six years. I joined Perfecting Peds in January and I'm currently chief of staff. Perfecting Peds is really unique, as in just in our overall mission and what we do. We're the first and only company to bring pediatric pharmacists to the outpatient space, so through health plans and private pay, we're able to see caregivers and patients through telehealth and we're able to spend a lot of time with them talking about their medications and doing a full, comprehensive medication management session.

Speaker 3:

I love my role there and I use nutrition a lot, but really it all stems from my background in nutrition. So my bachelor's was in human nutrition and I always found that just with like your diet and just daily living kind of helps treat a lot of things more than medicine does. I know, as a pharmacist, you would think that, like, pharmacists are all about medications, but I'm actually the opposite. I love being able to deprescribe and change things up with food instead of medicine, change things up with food instead of medicine. I've always loved to cook and I always love trying new recipes, but I think where this really spans is like a pretty personal story.

Speaker 3:

In undergrad my dad kind of had a really scary cancer scare where his iron levels were like a thousand percent the normal limit and he had to get like iron chelators and we just didn't know what it was and they thought it was cancer for some time. We got a biopsy and it wasn't cancer, luckily. But it was iron overload and it was simply from just too much iron in the diet, too much iron in the multivitamin and just like his body not really letting go of it. So his doctor said the best thing for you to do is to change your diet. So cut out all your red meat, try to limit your leafy greens, lose 18 pounds and you'll be fine. So my mom was an angel in this case. She transitioned all of all of her recipes. We're Vietnamese, so we eat kind of a lot of red meat. Like a lot of the diet is based off of pork.

Speaker 3:

So she transitioned all of the pork recipes to white meat, so things with chicken. So if you know Vietnamese food, you know that pho is made of like beef and everything the little meatballs everything is beef and pork and that's like what we live on, that's our comfort food. But my mom was able to change all the recipes so that she used chicken instead and she somehow made it all taste the same. So fast forward, I would say about a year, through changing his diet and losing the weight, becoming more active, my dad was able to get off of all of his hypertension medications, his high cholesterol medications, and he no longer had the iron overload. So that really instilled like the importance of food as medicine for me and it's something that I think about every day when I talk to my patients.

Speaker 2:

Wow, that's a great story. That really kind of was your your light bulb moment where you were like, Hmm, so is that what prompted you to go into nutrition in in general?

Speaker 3:

Yeah, I think it was. It was kind of like a serendipitous moment because it was. I was between athletic training and nutrition as my undergrad and that's where I decided like no, this is my calling. Like I think food is, medicine is really where I should take my talents, I guess.

Speaker 2:

Awesome, that's great. Well, that's really cool to hear. Thanks for sharing a little bit about yourself. Well, I'm excited to hear more about what you have to bring to the table for us today on this topic. So let's jump right in. If that's okay, let's introduce me to and the learners, obviously, who are listening today introduce us to just the concept of food as medicine. So we've said that several times now, but like what, what do we mean when we say food is medicine? So just kind of, maybe give us a little definition and maybe the origin of this concept food is medicine can mean things.

Speaker 3:

It can mean actual, like whole foods and using the foods to supplement instead of having to use a medication, or food as medicine to me could also mean like using a supplement instead. So a couple of examples of that. Everyone knows me and I think at this point everyone at Perfecting Peds will make fun of me because my two go-to like recipes that I tell people because for the most part, most of our kids have trouble with sleep and for the most part, most of our kids have trouble with constipation.

Speaker 3:

So my go-to for sleep is the Sleepy Girl Mocktail I love to recommend, just like a nice tart cherry juice, with or without magnesium. I try to do without magnesium because it causes diarrhea. But I like to tell the parents, especially for their adolescent girls, they love this little routine. So all it is is tart cherry juice, which is like a very sour but very whole cherry juice with ice, a little bit of lemon, and then you kind of put it in the cocktail shaker to make it a little bit fun for your child, and then they get to have it in like a nice cup every day before bedtime. So the whole thought behind it is that the tart cherry juice has natural melatonin in it, so it'll help you fall asleep. But it's also just forming the routine, making bedtime special and just adding that little special touch like okay, it's time for bed. So that's one of my favorites for sleep and then for constipation.

Speaker 3:

Everyone will laugh because I'm like chia seed pudding girl over here. That's something I've used for myself, that's. I'm sorry if that's TMI, but if you eat it at the same time every day, it'll regulate your bowels to the point where you won't really need it anymore. It's a very simple recipe. I like to do two tablespoons of chia seeds with like maybe half a cup of coconut milk, like straight from the can, if you put this into the fridge with like a little bit of maple syrup or something.

Speaker 3:

it'll gel up and kind of just make this like pudding texture and in the morning I'll typically like top it with fruit and just have that as like a snack. But it works as a great bulk forming agent and it honestly just makes the stools slip right out. So there's no need for Miralax or Senna or anything. So it's like my natural go-to food is medicine. Supplement wise, I also like to think a lot about supplements and how they can help.

Speaker 3:

In the hospital and just in general, we always tried to think of like not necessarily placebo, but evidence-based vitamins that are proven to help. So with a lot of neurological diseases the research shows that it's because of a deficiency in B vitamins. So like an example is the migraine vitamins is where we typically start as prophylaxis for a lot of our patients. So if it's their first time migraine they come in for like valproic acid or whatever IV protocol. We'll send them home with just migraine vitamins and that's fairly simple. It's riboflavin, which is vitamin B2, coenzyme Q10, and then plus or minus magnesium again. So it's like we add it, but then some patients complain of diarrhea. So we typically will do the riboflavin and CoQ10. And part of it could be placebo, but then a lot of it is also just the evidence that shows that it does work.

Speaker 3:

So, I think those are great stepping stones for just starting someone off with the concept of food as medicine.

Speaker 2:

Yeah, that's great, that's really fascinating. So, yeah, so much, so much, so many pearls there, the whole like watching out for magnesium because it can throw some into, throw some into diarrhea, or I mean just so much stuff. Yeah, so much to dig into. Okay, this makes me more excited to continue to talk about this because I'm going to learn so much from today's episode. So that's great, okay, so you've talked, you've touched a little bit about how nutrition obviously plays a role in disease prevention.

Speaker 2:

I think your, your personal story was really kind of highlighting how changing diet prevention. I think your personal story was really kind of highlighting how changing diet, exercising a little bit more, and not necessarily just like dieting. You know, I think people think dieting is like cutting calories and losing weight and whatever, but changing your diet is so important as well, and you know, your example showed how getting rid of the red meats and moving to white meats and things like that, like just those simple changes, can make a world of difference. So I think you've touched on those, which is really great.

Speaker 2:

Are there specific, yeah, other things that you want to share with us so very much, like here's a treatment for constipation, here's one for sleep? Are there any other ones that are really popular for you? Because obviously I'd imagine in the PEDS space you have a lot of ADHD patients, right? So you have a lot of stimulant use and that's possibly why we have some constipation issues, correct? So are there any other common ones that you see often and maybe just necessarily peds? I'm sure that you have some remedies for adults as well, but are there any others out there that you know in that whole sense of the definition of like food as actual medicine, in a sense of treating something like any? Any tips or tricks for us on that?

Speaker 3:

is one we definitely see a lot and I'm always like team non-stimulant. Um, just because of the stimulants I feel like there is such a slippery slope Like you start a stimulant, your patient then has insomnia, they have appetite suppression, Like the list continues on with the amount of side effects. A lot of these kids end up on a stimulant, then on ciproheptadine for appetite, then on a growth hormone because their growth is stunted and then they need like trazodone or something for sleep, so that one medication then becomes four and then it just becomes that super slippery slope of polypharmacy. So for ADHD I always try to start off with vitamins. So there's good evidence on fish oil and I guess with the fish oil the biggest pearl is trying to find one that doesn't smell as much. And then if you do find one that is like semi-okay with smelling bad but not too much, you can also freeze them.

Speaker 3:

And that helps suppress the smell a lot so fish oil is another great one. There's a lot of great emerging evidence right now on vitamin D and how that helps with ADHD as well, so I do like to make sure that everyone's vitamin D levels are good. They're out in the sun, they're taking a supplement if they need it. Other ones are always B vitamins, so B vitamins are always something that help with the brain. So vitamin B for vitamin brain, and then there is some evidence on like magnesium and zinc as well, but I feel like the breath is not as much there.

Speaker 3:

One of the big ones that we do do and my bread and butter definitely is epilepsy is the ketogenic diet. So that one, the history of it, is pretty interesting. So these patients with epilepsy were seen as possessed in the medieval times, so they would starve them and then they realized that when they starved them, that the seizures would go away. So there's this kind of this concept of like starvation, but like really carb, carb depriving. So patients that are put on the ketogenic diet typically will start off at a ratio of like one to one, so one gram of carbs to one gram of fat, and then it slowly increases and the goal is four to one, and once they reach like a level four to one.

Speaker 3:

There's so many things that like a pharmacist can do Like I know it's a diet and I know that it's like a lifestyle change. So they end up changing their diet completely. Where they can't have many fruits and vegetables, they're eating pure fat. So I was a camp counselor and a lot of the epilepsy kids would have to come with their like keto diets packed and it would just be like five avocados, alfalfa sprouts and like MCT oil and then eight things of bacon and that was like what they would have to eat.

Speaker 2:

Wow.

Speaker 3:

So there's like the diet component of that. But then from a pharmacist perspective, with the ketogenic diet, pharmacists have to do a lot of the carb counting with medications, counting with medications. So with kids we have to get really creative in like tablet crushing, making sure that things can be like kind of calculated because the doses are so little and they're so specific. So just having all the calculations out, having the dilutions for the medications and just making sure that if it is a medication that has to be given via oral solution, it has the least amount of carbs possible. So there's that component of the ketogenic diet. And then there's all like the lab monitoring. Because you're just having pure fat, there's a lot of your cholesterol monitoring.

Speaker 3:

Ketogenic diet also puts you into ketosis, so the patients are at risk of acidosis. So we're constantly tracking that constipation because they're just mostly eating fat and like I guess fun fact their stools get very like kind of slippery and weird fatty. And then there's also beta hydroxybutyrate monitoring. So just monitoring and making sure that they're always in ketosis. It's a ketogenic diet is like probably one of the most tried and true and I know that a lot of people use it to like lose weight and stuff, but I would never recommend it because I know that it can do so much to your labs and it's actually quite dangerous if you're not monitoring it correctly.

Speaker 2:

Wow, wow, great tips there. I think so many take-homes from that, but I think the one that struck me the most and this is probably dumb for me to admit is realizing that some medications have carbs in them, like. I think that that that was just a light bulb for me where I'm like huh.

Speaker 2:

I never really thought about it that way, you know, in a sense of like you just think about taking a pill or whatever and you don't really think about it counting towards something. But if you're actually like watching carbs, then okay, that's really. That's interesting. Yeah, great point for these kids.

Speaker 3:

Their goal usually is like less than a gram of carbs per day from the meds and for the most part, like most tablets and stuff and like powders don't have that like. The carbs are pretty good, but things like packets you'd be surprised. Like a Nexium like SM eprazole packet has three grams of carbs per packet, so that's already like three times the amount that you would, yeah, that you would have in a day.

Speaker 2:

Oh, I was going to say, if you think about, you know peds or children that are having issues a lot of them it could be swallowing issues or you know they have a feeding tube or whatever, and so you know these sort of packets are things that you're going to be, that you're going to be using for those patients because they maybe can't swallow a pill. So yeah, I know that I was telling Jenna in our previous episode your colleague that we've had on another episode. I do have two nephews with special needs and I know a lot of their early life was feeding tubes and a lot of packets and a lot of, you know, medications were given in that way. So, yeah, another light bulb there just to consider that different formulations are going to have different quantities. So yeah, very cool.

Speaker 3:

The newer drugs that are hitting the market, luckily, are carb free, so we're able to circumvent that because everyone's realizing that, like if a kid gets to this point where they need something like cannabidiol, which is epidiolex, that's carb-free, so then that's pretty safe. But then you run into the issues with the feeding tubes, like what can be given via which tube, what is absorbed where? So can it via J, via G? A lot of meds can't be given via J, like cannabidiol, or Epidiolex is one of the ones that can't be given via J. So it becomes super complicated when you're transitioning patients onto these diets. But for some, where it works, it works really well, so it's like life-changing.

Speaker 2:

Wow, that's great. Okay, so we've touched a little bit on, obviously, the relevance to pharmacy and the whole idea of food is medicine. But tell us what a pharmacist's role could be or is or what have you seen with this whole concept of food as medicine. So tell our learners a little bit about how can they dip their toe into this concept and really kind of start transitioning practice.

Speaker 3:

I think a lot of it is in reading the literature and like being equipped with the right knowledge. Because I know a lot of people will come to you with like, oh, this herbal supplement and this and that. So just knowing that it's not as regulated as a prescription drug and just knowing that you have to counsel patients on interactions, because people think, oh, ashwagandha, or like this lion's mane mushroom, it's, it's pure, it's fine, yeah, but then they end up really interacting, sometimes in really scary ways. So just knowing that you kind of have to take everything with a grain of salt and you also have to be very confident in telling the patient like, hey, I love the idea of you wanting to transition to more like foods and more dietary supplements, but remember that these are dietary supplements so they're not as regulated as your medications, so I'm totally okay with it. You kind of have to convince them that you support it, just so we have an open relationship and they'll tell you about these things. But then you also have to look at it with a fine tooth comb.

Speaker 3:

So like using the right databases. Luckily a lot of our like run of the mill drug interaction checkers. You can enter these like supplements and like foods into it and even things like garlic, it'll run. I kind of always do that because, like, things like garlic and ginger can't be given with anti platelets because they increase the risk of bleeding. So, just like knowing that background knowledge will help and I think the more, the more you enter things into drug interaction checkers, the more you learn. So I think just that's like one of the biggest things a pharmacist should do is just to like educate yourself and then also educate and empower your patient.

Speaker 2:

Yeah, that's great. I know that my when I had my pharmacy many years ago. One of the one of the things that would frustrate me the most is when a patient would come in and say I saw Dr Oz, that I need to start taking this, and I'm like, oh man, we're on another supplement, they're pushing on a commercial break or something. So yeah, it's interesting. So you mentioned, I know we obviously don't want to give out like specific resources or whatever, but do you have any go-tos? Like, are there things like, if someone wanted to, you said, read up about it? Like, do you recommend, is there like a book or is there someone who has done a lot of this research and kind of meshed a lot of articles and different things together for someone who really wanted to kind of gain more information in this area?

Speaker 3:

This one isn't really like advertising anything but the NIH has a lot of great resources. There's a great natural like database, so I like to use that.

Speaker 3:

But, just honestly, any drug interaction checker will like point you in the right direction and you can basically like look, I don't really use books as much. I like to reference studies because they're a little bit more up to date. But I do think there's a lot out there and, like the NIH has a lot of great resources, so I guess like plug. I did publish a paper on like food and drug interactions, so that is another great place to start?

Speaker 3:

Yeah, because there are a lot of food and drug interactions that can interfere with the way your medicine works too. So I guess, on the flip side of things, food as medicine, food can interfere with medicine.

Speaker 2:

So Well, there you have it. Yeah, so listeners, remember her name and just put that into your search bar and find the article and start there and then kind of go from there. Yeah, that's great, awesome.

Speaker 3:

I have a lot of good resources in that article, Cause I I made like a really big chart on the different food and drug interactions.

Speaker 2:

Oh, wow, that's great. Okay, so we talked a little bit about some of the chronic disease states that you know can be affected. You mentioned epilepsy. Obviously, we all know that diet can very much affect diabetes and hypertension, but are there any other chronic disease states that you know can really be affected by this concept of food as medicine? I'm like really being aware of you know what's going into the body and what can affect other things.

Speaker 3:

I think the one that comes to the top of my mind just because I have migraines all the time is migraines. So, instead of it being like one where you're using food as medicine. It's one where you're kind of avoiding food as medicine.

Speaker 2:

Yeah.

Speaker 3:

So like avoiding high tyramine foods. So when I think tyramine, I think of it as like all the things that I love, so fermented things like cheeses, wines, chocolates those are all triggers for migraines. So when you're educating patients, that's like another great place to start, like, hey, you should avoid these things to prevent your migraines. So when you're educating patients, that's like another great place to start, like, hey, you should avoid these things to prevent your migraines.

Speaker 2:

Well, yeah, that's good. My oldest nephew, I remember back in the day, he had migraines at a very young age and they determined that one of the triggers for him was hot dogs, which you know is a common, a common food for a child. When you go to the nice restaurant, on the kid's menu is a hot dog or a hamburger, you know. So they realized pretty quickly that every time he would get a hot dog he would end up having terrible migraines. So, yeah, so that's another great point in the sense of not only is it things that you can eat, that you've given us examples for that can affect, but things that you should avoid that are trigger points or things that can, you know, worsen your disease state or interact. So okay that's great.

Speaker 2:

So let's talk a little bit about again if I were a pharmacist who was looking to learn more about food as medicine and start maybe implementing it into my practice, so if I was an independent pharmacy, community pharmacy, or even if I was inpatient, you know what are some things that I could. How could I really start like implementing this Slowly? Obviously there's no reason to jump full force down and cover your head with it, but what are some ways that we can kind of start out basic on this?

Speaker 3:

I think a good way to start out basic which is kind of what I started doing this week actually is having like a playbook for it, so just having like your go-tos and your quick references, just so you can look back and I'm sure there are certificates out there for food as medicine but just like learning and really educating yourself and then also just incorporating it into not only your own daily life but then just like incorporating it into your patient's lives. So I think, like for community pharmacists, the best way to start is by counseling and like taking the time to really talk to your patients and then, in the inpatient setting or in a hospital is just like taking that extra step to run the interactions with the food. There is a drug interaction checker that actually allows you to choose foods, so that's really cool. But just like taking that extra step and using that detail to guide your like, guide your practice, I think.

Speaker 2:

Yeah, that's great. I love the idea. I am a I'm a sucker for a good schedule or a plan or an organized book on something you know structured. So I love the idea of creating kind of like a playbook, like you said, where you know, maybe you read something in your article and it sticks and you write that down so that when that comes up with a patient you know what to recommend. Or you know the idea you gave us earlier with the chia seed pudding, you know for constipation, like just kind of these little tips and tricks, and you just kind of keep adding to it and it's kind of your go-to. So, yeah, I really liked that idea. I'm also old school, so that would be for me. That would be on pen and paper, that would be like really old school. It wouldn't even be electronic.

Speaker 3:

So I'm like a big Canva girly. So I started making like these infographics to train our pharmacists because, like, when we're on calls, they're like oh, I didn't know that, I didn't know that. Like, oh, you always bring up these things Like, can you write them down somewhere? So I started making infographics Like these are my favorites for migraine, these are my favorites for ADHD. So I'm just like formulating a little like book of infographics for the pharmacist to use.

Speaker 2:

Wow, that's great. That's really, that's really innovative. I like that. That's really good. Okay, cool. So let's talk, let's jump a little bit about opportunities as well. So we, you know you've given us a tip of how we can kind of start slowly expanding our mindset into this practice. Are there opportunities there that await us for collaboration? Like, are there ways for us to collaborate with other healthcare professionals in this space and make them aware of things? And you know, obviously, when we have a complex patient, how, how can we kind of bridge that collaboration gap there too?

Speaker 3:

So I collaborate a lot with the dieticians. I think I'm a little biased because my background is in nutrition, but I always go towards like the dietitian, because a lot of things just stem from maybe their diet Like, let's say, you have a patient who is like losing weight or who is just not meeting, like their, their goals or for whatever reason. So the first thing to do is to talk to the dietitian, like maybe their formula is off, maybe they're flushing their medications with too much water and that's diluting the formula and they're not gaining the right amount of nutrition. So I love collaborating with nutritionists. But then my other favorite right now is SLPs. I've learned a lot about dysphagia and I find that it's really important to know if a patient can swallow properly.

Speaker 3:

So a lot of times when a patient looks sick, if you think about how many things you have to swallow in a day- you have to swallow your food, you have to swallow your medicine If you're a chronic person on lots of medications and then you also have to be able to swallow saliva. So if you're not able to swallow those three things that can cause you to be sicker than you would normally be. You would lose weight from not meeting your dietary needs, you would have your chronic diseases exasperated because you're not able to take your medications, or you would just be over salivating and you would just be choking on your saliva. So that's like a great person to collaborate with as well when you're thinking of like food as medicine, because that's the source of being able to absorb the food being able to swallow it that's yeah, that's fascinating.

Speaker 2:

So, to clarify for everyone, can you define what an slp is?

Speaker 3:

just oh yeah a speech language pathologist and they're honestly magical creatures. They do like all the swallow studies and they do a lot of the assessments and I guess one of the pearls there that I learned is, if you are suspicious, go ahead and ask for a consult, because I think it's. The statistic is 25 of children have some sort of a swallowing issue, so they're able to like use therapy or thickeners or different textures and consistencies to help these patients swallow better.

Speaker 2:

Wow, yeah, we have a cousin that's an SLP and so I am a little familiar with the space. But yeah, I mean, I agree they're magical in a sense of sometimes what they can solve or what they can get down to the root cause of and figure out, is just it's can be so beneficial. So, yeah, okay, great. That's another great tip. So you focus on your dieticians as well as your SLPs and obviously you know then if we're affecting other chronic disease states and clearly we can get into that specialty provider and prescriber space as well, with collaboration efforts too. So that's great. And prescriber space as well, with collaboration efforts too. So that's great.

Speaker 2:

So what are some challenges that our pharmacists could face? Who might be trying to dip their toe in this water? So clearly I'll go ahead and call out the elephant in the room. One of that would be training. I would be the first to admit that probably very few of us received a lot of training about this in pharmacy school. It's just not a very huge topic. There are a lot of training about this in pharmacy school. It's not just, it's just not a very huge topic. There are a lot of schools that have, I think, elective courses on, you know, supplements or nutritional therapies or whatnot, but so clearly I think, limited training and limited knowledge, which we've talked about, how we can kind of get up to date on that. So what are some other challenges you think that we might face that we need to strategize to overcome?

Speaker 3:

I think limited evidence is another big one because people aren't really doing groundbreaking research on like lots of like medicine. I mean not medicine, foods as medicine, just because a lot of times it's a little bit, I think ethically it's kind of hard to do like a randomized control trial and have someone on just food and someone on the medication. So I think the research is a little bit scant. So a lot of the things you read the evidence is kind of on the lower side. But then you have to think about like risk versus benefit.

Speaker 3:

A food will carry less side effects than a medication, so it's always kind of worth a try in the beginning. But then always counsel the patient like yeah, we can try this out initially, but if it doesn't work after X amount of time we should definitely like talk to your doctor and formulate a plan with medication Cause, like if you really need the medication. Obviously we're not going to push you to not take the medication, but we can also try diet, not only, as I wouldn't say, as a full substitution, but just like as an adjuvant for the most part.

Speaker 2:

Yeah, ok, yeah, interesting. So I think it goes. You know also I'll call out the other elephant in the room there's no money with researching these sort of things, right? So you know you're not going to have a groundbreaking study on the benefits of spinach and the use of whatever, because you know there's no money. That follows that.

Speaker 2:

So, unfortunately, but that's why you know, earlier I was asking where, what are some resources that patients can that our, you know healthcare professionals can go to to kind of try to see where some of these things have been studied or looked at or documented over and over. So, yeah, that's great, but obviously pharmacy is hurting right now in a lot of different sense. I just actually saw a statistic yesterday that was heartbreaking the number of pharmacies that have closed already in 2024. And you know a large portion of those are independent pharmacies, which they're very near and dear to my heart. So it's just, it's a really hard time right now. So obviously, reimbursement and getting paid for your services and you know all of that always comes up. Are there any sort of strategies to help with that? Because you know you mentioned taking more time to counsel the patient. Well, that's taking time away from other things and you may not be getting paid for that particular service, so do you have any other? Maybe some tips or brainstorms that you'd share with our learners on that?

Speaker 3:

I would say get creative. I think that's one of the coolest things I learned from joining Perfecting Peds is that there's so many cool like pharmacist innovators out there who are just like changing the game, like breaking the ceiling, basically on what our profession is. So there's a lot of billing codes out there that you can use and just like knowing how to bill, knowing the space and just even offering things like private pay. These are valuable services that people will pay for. It's just about how you market it and how creative you can get.

Speaker 2:

Yeah, I think that's so key. I've been screaming that for years. Like you know, we give away all of our services for free and we're so knowledgeable and we have so much to offer our patients, we're so accessible. You do not have to have an appointment with us. You know all these things and and then, but yet we're so afraid to, like, charge for that. And there are so many people um, if you know they're able to pay, obviously that are willing to do that for different services, especially if you're taking 30, 45 minutes to walk through a nutrition plan or to walk through certain medications that are being affected by their diet or something. So, yeah, that's great feedback as well.

Speaker 2:

All right, so in our last little bit, let's jump into implementation. So you talked a little bit about being creative with, you know, marketing that and things like that. So how can pharmacists who want to kind of start in this space, how can we get the word out to our patients, like, what are some ways to actually implement this? The playbook was a great one as well. Just kind of keeping that and listening for things that your patients ask over and over and always having a go-to. But do you have any other tips for how we can implement this in a kind of like daily practice.

Speaker 3:

It ends up being a lot of just like word of mouth because, like, your services can only like go so far along the lines of like marketing and stuff. So just taking a social media, being very creative, going to different like groups and like just reaching out, I think is the biggest way. There's not really a great way to market a single service like this, especially if it's just in your own pharmacy, but then also in a community pharmacy. You could offer the first service for free and then see if they like it and then you can move from there.

Speaker 3:

So just getting creative with things like that I'm taking to LinkedIn. Linkedin is a great resource for connecting with other people and just finding partnerships. So I would say just you need a lot of grit. I think grit and creativity to get it going.

Speaker 2:

Agreed, you know, and it could just be something as simple as promoting you know to your patients like it's okay to ask questions, like I'm here for you. I know I look busy, I know I am busy, but if you have a question to ask, and you know that can just you never know what that question is going to be, if it's going to be in that space, and that can lead to more questions and more answers and more opportunities to help guide your patients.

Speaker 2:

So, yeah, okay that's great, all right, so just a little bit, if you can touch on how you think this affects. We try to bring all of our podcasts back to impacting the community and like really trying to solve some of the issues that we're seeing in our communities. So how do you think that this impacts the communities that we serve this whole concept of food as medicine and embracing this idea that we have to watch for these things Like these are not just one-offs like these are. These are proven things that are evidence. Some of these are evidence-based and we have to really kind of be careful.

Speaker 3:

So I think food as medicine really impacts quality of life because it gives you a holistic view on what makes you healthy. So medications can make you healthy and can help with a lot of chronic disease states, but you really have to get to the root cause of it, and it's your diet. It's your exercise, but 80% of it is diet. So just thinking back and thinking about your body as a very like secret space where you're putting only the best into it is a great way to look at it.

Speaker 2:

Yeah, that's great. I love the getting to the root of the problem because it's just, it's so important. I always told my students when I taught and I even a lot I make references to it but one of my favorite shows of all time is Murder she Wrote, which I'm going to show my age a little bit there. But so I always tell them they have to be, you know, they have to get their inner Angela Lansbury or JB Fletcher, who the character she played. She was always so inquisitive and she, you know, asked the question. She got to the root of the problems. You got to put on that sleuth hat and really kind of get to the root cause of the problem. So, yeah, that's great advice as well. Okay, so to wrap things up, mary, well, first of all, is there anything else that I didn't ask you that you're just like dying to tell us or any other tips or tricks or anything, or do we pretty much cover everything?

Speaker 3:

Pretty much covered everything. I felt like I was like blabbing away, but this is honestly a passion of mine.

Speaker 2:

No, it's great blabbing. If you felt like it was blabbing, it didn't feel like it to me because I mean, there were so many nuggets and tidbits and pieces to like go look up more and, you know, take home and whatever. So that's great. So a question I always like to end the episode with obviously it's the Game Changers podcast. So what do you think? Just to summarize for our listeners out there, what's the game changer here? Is the game changer the concept of food as medicine? Or is the game changer that pharmacists have a role in this space? What's the game changer here?

Speaker 3:

Game changer. Here is what you do with food as medicine.

Speaker 2:

Yeah, that's perfect. Yeah, and we've given you some opportunities. You can be as simple as learning a few key things and keeping it in a playbook that you kind of pull out for your patients, or you can become super passionate about it, like you, and it be, you know, part of your everyday practice with your patients. So, yeah, that's great, that's awesome. Well, that's all we have time for this week. Thanks again for joining us, mary. This was super enlightening and very fun. Thank you.

Speaker 3:

Thank you so much for having me.

Speaker 2:

Yeah. So if you are a CE plan subscriber, be sure to claim your CE credit for this episode of Game Changers by logging in at CEimpactcom. And, as always, have a great week and keep learning. I can't wait to dig into another game changing topic with you all next week. Until next time, you