Dr. Tracy Morton is a Family Physician working at Haida Gwaii Hospital and Health Centre (Xaayda Gwaay Ngaaysdll Naay) and a Clinical Associate Professor with UBC. He has a love for travel, kayaking, meditation, and wellness. We talked about the intersection between natural health products/supplements, patient care, diet, and the unique realities of being a rural doctor in Northern BC.What motivated you to get into medicine and become a doctor? It seemed the best way to see the world, as a vehicle to travel. Work to travel, and travel to work. What’s one of the most rewarding aspects of the job? As I’ve gotten older and more settled into my community, most rewarding is the immersion into the lives of others. Long term commitment to place allows a deeper, mutually rewarding integration into the community, allowing me to work on the more deep rooted social determinants of health underlying illness and wellness. Do you think doctors really don’t get enough nutrition training in medical school or do you think diving deeper into that should be left to dieticians and nutritionists (given how intensive med school already is)? Nutrition is not covered as well as it should be. And even if we are to get plenty of information, there are overwhelming societal forces behind diet fads. Remember eating for your blood type? I’ve seen health crazes come and go, each believed and promoted by all kinds of people hoping for a magic bullet. What doctors can be aware of are some of the latest evidence behind the mix of macronutrients most healthful. There are plenty of recent trials looking at low carb diets, running counter to the advice of the nutrition establishment which still focuses on carbs as a foundation of Canada’s food guide. What are some of the most evidence based dietary supplements or alternative medicine modalities you’ve come across? The conventional medical literature has a lot of natural product publications. One has to be looking for it though. Too often the focus is on pharmaceutical trials at the expense of supplement trials. Omega 3s have a solid foundation of evidence now. Niacin, St. John’s wort, bearberry, D-mannose, and probiotics are in the same category. When and how would you consider recommending them to patients? All the above, I offer to patients daily or nearly every day especially for chronic conditions. For serious emergency conditions or surgical conditions, I don’t see supplements or herbals playing much of a central role. Do your patients usually talk to you about any dietary supplements they are taking? Sometimes, but a question is usually required to elicit this information. It is not commonly volunteered. Are you happy with the resources you have available as far as checking on potential interactions with dietary supplements and any medications your patients are on? No, the point-of-care apps I use don’t have interaction checkers, nor do pharmacists routinely check. This is one area that could use some work. What do you think of how natural health products and dietary supplements are regulated in Canada and the US? I am a big fan of NP licensing. I feel bad for some of the smaller companies burdened with the regulatory requirements, but once I see an NP number, I can recommend these products with some degree of confidence. The licensing and research process puts these products on a par with pharmaceuticals and allows me to have some sense of dosing. Without it, it’s the wild west of product choices—there is little standardization among brands selling apparently the same product. Probiotics is a good example. I’ve seen studies showing live, active cultures in different products ranging from 0 to 50 billion. Quite a range to stake a health claim on. I would like to see more natural products enter the mainstream and Health Canada’s NP registration process is one way to do that. What dietary and lifestyle preventative health measures can have the biggest long term effects on people’s health and are North Americans generally doing them? Getting moving. It is very difficult to buck the addictive immersiveness of the digital environment. If I said to you 20 years ago that in 2017 you would be spending 12-14 hours in front of a television every day, you would be horrified and not be surprised to find yourself become obese. The screen access we have is ubiquitous. And it’s only going to get worse with virtual reality environments and self-driving cars and the “always on” access we have to the internet. If we got 30 minutes of aerobic exercise five times per week, we would all be healthier. We’ve got to place a higher societal priority on moving. Obesity and the sedentary lifestyle are the new smoking. Are there any common nutritional deficiencies you see in your practice? For example, being in a more northerly location, vitamin D? Vitamin D deficiency in Canada is extremely common, even to the point that we are advised we shouldn’t be testing for it. The test costs $100, and if we mass screened everyone, BC alone would spend $500 million. The commonest advice is to recommend supplementation with vitamin D 1000 units daily year round. It won’t hurt and can improve well-being, balance, bone health, immune function, lessen autoimmune disease risk, and might reduce risk of cancer. What do you think of some of the specialized diets being followed? For example, vegan, paleo, raw foods, ketogenic/high fat diets? Lots of these are healthy but unsustainable for most folks. I’m a fan of vegetarian diets as meat is a carcinogen and brings all kinds of environmental costs, not to mention an ethical burden to those choosing to eat meat (whether or not they care to admit it). Lower carbs and whole foods are probably the healthiest over the long run. I’m intrigued too by the research into longevity and the relationship to fasting and hypocaloric diets. Have you ever had patients following the ketogenic diet? Why does it seem to help with epilepsy? What kind of health issues or side effects could come up? Not many. The ketogenic diet is not sustainable for anyone except those with refractory epilepsy. It’s a good weight loss diet, but I’ve never seen anyone last more than a few weeks—when the weight then returns…and then some. How much promise does a ketogenic diet hold for issues like obesity, diabetes, heart disease, and neurological disorders? Not much, I’m afraid. Low carbs is more sustainable than no carbs. Are there any local Haida Gwaii dietary/food based movements or shifts that are happening that you see having positive or negative effects on health? Eating a huge amount of fish isn’t so much a “movement” as it is a way of life. It’s integral to the culture here and is even a kind of alt-economy, traded and bartered for services, offered as gifts. As the environment becomes more stressed and a carbon-economy becomes more entrenched, the global food economy will become less available and too cost prohibitive to survive here. Reliance on local foods is going to occur everywhere but first in places like this, which is remote. If you could go back in time and give one piece of advice to your first year med school student self, what would it be? Good question. I would probably tell him to do a meditation retreat at least yearly. Regularly meditating can entirely reorient one’s view and understanding of reality.