Ep. 34: Pamela Fergusson, PhD – Supplements and Post-Injury Nutrition

00:00 – excerpt from the episode
01:13 – intro (listen to discover a little more about your host. Martin will tell you a new lesser-known fact about Dr. Maya)

01:48
Dr. Maya Novak:
I’m a huge fan of getting your nutrients from whole food. But there are many reasons why that isn’t always ideal – for example, the quality of food you can get (which can vary depending on location, time of year, type of soil, and so on). It also depends on the diversity, and of course, your body’s needs, which can vary based on your own makeup and conditions such as injuries. So nutritional supplements are often a valuable tool for maintaining (or regaining) your health… But the question remains - which supplements and how to choose them? Dr. Pamela Fergusson was a guest on my summit in 2019 and because this interview helped so many people back then, I cannot not share it with you on my podcast. Please enjoy and let it help you.

02:39
Dr. Maya Novak:
In this interview, I’m joined by Dr. Pamela Fergusson who is a registered dietician with a Ph.D. in nutrition and over 15 years of experience with changing lives through better nutrition. She is also a member of the Dieticians of Canada leadership team, on the Sustainable Food Systems Leadership Team, and the advisory boards of Balance and Conscious Eating Canada. She has worked as a dietician in North America, Europe, Africa, and Asia for organizations such as UNICEF and the World Food Program. Pamela, thank you so much for being here.

03:13
Dr. Pamela Fergusson:
Thank you.

03:15
Dr. Maya Novak:
Before we go into the really juicy parts of supplements and nutrition, I would love to hear about you and your story. When did you decide to go for nutrition, and why did you decide to become a dietician?

03:33
Dr. Pamela Fergusson:
When I first went to university actually I was considering becoming a medical doctor and I attended a lecture where they were speaking about nutrition and they mentioned that 80% of chronic disease has some root in nutritional causes. I just thought wow, what a powerful thing to realize the fact that we could be helping to prevent disease instead of just waiting until disease occurs and then trying to cure it. So I became inspired by nutrition and realized that we could be really improving people’s lives by improving their nutrition and then hopefully they don’t develop as many of those chronic conditions. Then even after they do develop them, nutrition has a powerful role in improving quality of life, reducing symptoms and, for some people, even turning those conditions around. Even chronic conditions like diabetes or heart disease can be dramatically improved through diet.

04:44
Dr. Maya Novak:
Yeah, when I learned that years ago I was like, why does nobody talk about this, you know?

04:51
Dr. Pamela Fergusson:
Right.

04:51
Dr. Maya Novak:
It just feels it’s just supplements, but no one is actually talking about the diet. Food can actually reverse some of the things. Yes, it’s just amazing. So here, we are talking mostly about injured people – injured women, injured men – and when an injury incurs, when they have an accident and especially when we are talking about fractures, the most common supplement that people think about is well, I have to start eating calcium supplements, or calcium plus Vitamin D. Can you talk a bit about calcium as a nutrient and calcium as supplement?

05:34
Dr. Pamela Fergusson:
Sure. Calcium has an important role in our body in terms of remineralization of our bones. So it is important, particularly if someone’s maybe had a break or a fracture, then calcium can have an important role in helping to heal that break. I would say that we can look to supplements and, certainly, it is a good idea to take, I would say both a calcium and a Vitamin D supplement. But, it also wise to look at your diet in general. So we don’t need to only look at supplements. You can also be looking at wholefoods. This is something I just want to say overall, for everything that we’ll be talking about today. Supplements do a play a role, especially when there’s been an injury and we really want to maximize our body’s healing potential, but really, we absorb nutrients best through whole foods. So, whenever possible, we should get them through whole foods. I work from a plant-based perspective, and I really believe when we’re talking about disease and injury, we are working to try to minimize the inflammation in the body. That’s one of the main things. You said – it’s really inspiring at the start that you said really activating our body’s own healing mechanisms. One of the most powerful ways we can do that is by reducing the inflammation we have in our bodies. So I believe in practicing from a plant-based perspective. If you’re listening to this and you don’t eat a lot of plants, maybe you’re not getting a lot of your nutrition from plants, I would encourage you to just make that shift and start moving in the direction of a more plant-based diet. Because reducing inflammation is not only about what you eat, it’s also about what you don’t eat.

07:52
Dr. Maya Novak:
Yeah, well, I know that the way I was raised, calcium meant yogurt and milk and things like that, and also all the advertisements, more or less tell you that if you want calcium from food you should be eating dairy products.

08:12
Dr. Pamela Fergusson:
Dairy, right. Yes. So I would say that we can look to the plant kingdom as well for our sources of calcium, and there you would look to beans, legumes, nuts, seeds. Sesame seeds, for example, are a good source of calcium. You could make a tahini dressing, that’s a simple addition that you could make to your meals. Tofu is also a good source of calcium and I know a lot of people are afraid of soy. I would encourage to really let that fear go. We can safely consume two to three servings of soy per day and I would encourage you to choose the less processed options like edamame or tofu or tempeh. Those are also wonderful sources of calcium. Certainly, I’m not discouraging people from taking a calcium supplement. That’s a wise idea. But you can also be thinking about food. Let’s not forget about food. And also, as much as you are able to, getting some amount of weight-bearing exercise. I mean this should not go in contradiction to what you’re being advised by your medical team. If your doctor is advising complete bed rest, then obviously that’s what you need to do. But as soon as you are able to get up, move around, even if it’s a simple thing like going to the supermarket and doing your grocery shopping. Continuing to do some weight bearing exercise through your recovery, whatever you are able to do that won’t cause further injury, and in line perhaps, if you’re seeing a physiotherapist, they may have some suggested exercises for you. That will also help you to keep your bones strong and help to build healthy bone as you are achieving that healing. I don’t know whether we’re speaking only to people who have had fractures and those kinds of things, but there could be other muscular injury and that kind of thing. It’s certainly valuable to keep up with some level of activity so that you don’t end up losing bone density or muscle strength, even core strength, during the time that you’re injured. So thinking of nutrition, I want us to think of supplements, but also whole foods. But then also that other side of continuing, as your medical team is advising you, with whatever activity you can continue with remembering that that also helps to maintain healthy bones.

10:58
Dr. Maya Novak:
Yes, I love that you mentioned this. I remember when I was lying in bed for three months because I was non-weight bearing, and then slowly started using my body again. And, of course, your body changes in that period of time. I know that many people are afraid of activity when they get permission, for example, for partial weight bearing. My experience is that you usually get the green light to slowly start doing this when the bone is not completely healed yet.

11:12
Dr. Pamela Fergusson:
Right.

11:12
Dr. Maya Novak:
Because the pressure – please correct me if I’m wrong – because the pressure also helps the bone to heal.

11:48
Dr. Pamela Fergusson:
Heal – right – and also, again, I want to say I am not an orthopedic surgeon. This is not my area of specialization, but I believe that it’s also going to help the bone to set in a healthy way rather than if you’re lying down. That’s not the natural way that we move around in the world. So spending some time upright will also help, I believe, the bone to set in a healthy way. So remembering these different components of activity, we talked about Vitamin D, well the best way to get Vitamin D if you’re able to is to get it from the sun. You can get it from a supplement. Fortified foods are also an option – we can talk about that. But the best way is from the sun. Now if you are like me, living in Canada and we’re in the winter season right now. Unfortunately, we cannot rely on the sun here for Vitamin D, and that’s the same for the Northern US and Northern Europe. But if you’re in Southern Europe, or the Southern US, or it’s summertime – thankfully, we’re coming into spring and summer – then getting outside. Even if that means that you and sit in the garden with a book and you read for a little while. Getting that Vitamin D will help with your bones, and like I say, there’s no better way than to get it from the sun. Fortified products also are useful. You may want to check, for example, if your non-dairy milks are fortified with Vitamin D, that kind of thing. But really the main source that we get our Vitamin D from is either the sun or from fortified products, or from supplements.

13:34
Dr. Maya Novak:
Perfect. So you mentioned dairy and then non-dairy milks or products a few times. Do dairy products play a role in inflammation in the body or not?

13:50
Dr. Pamela Fergusson:
I think there’s mixed results in that. I have looked quite a bit into the science on that and in some cases, some people do seem to be sensitive to dairy and therefore they will have an inflammatory response to dairy in the research. Other people seem to be able to tolerate dairy better. That likely relates to your genetics to some extent, your ethnicity, people from different cultures sometimes have a higher propensity to lactose intolerance, for example. So it depends really on your tolerance for dairy. We can’t say universally that dairy is inflammatory. However, I would say when we are looking to an anti-inflammatory diet what we absolutely know is anti-inflammatory. There we want to be removing added sugars. We want to be removing trans-fats. We want to have a lower intake of animal protein in general, and dairy is included in that. And we want to increase the amount of plant fiber in the diet. So we are looking to lots of fruits and vegetables, green vegetables, high fiber foods like pulses. Nuts and seeds are wonderful food sources of Omega 3 fatty acids so they are also anti-inflammatory healthy sources of fats. Also, some whole grains for their high fiber potential as well.

15:38
Dr. Maya Novak:
Great. So whether we are talking about foods and getting calcium from food, or whether we are talking about supplements, how much calcium do we actually need and is it different when we are injured? Do we need more calcium or is it the same?

15:57
Dr. Pamela Fergusson:
We need around 1000 milligrams of calcium a day, and when you’re injured you may want to bump that up to say 1200. I don’t think that there is specifically an RDA set out for people who are injured, but I think you would want to make sure that you were at least meeting your daily requirements and maybe even exceeding them slightly. A supplement will help you to do that but, of course, you can also rely on food. Like we said, your food calcium – the calcium that you get from food will likely be better absorbed than that that you’re getting from fortified products or from supplements.

16:39
Dr. Maya Novak:
Great. So how about other things - I know that a lot of people are really huge fans of coffee.

16:48
Dr. Pamela Fergusson:
Sure.

16:48
Dr. Maya Novak:
There are some articles and studies that are a bit confusing. Does coffee or caffeine affect calcium absorption or depletion?

17:02
Dr. Pamela Fergusson:
Yes. I think you should drink moderate amounts of coffee. Maybe two cups a day is fine, and don’t take your supplements with coffee. So if you wake up in the morning and you are having a coffee with breakfast, that’s not the time to take your supplements. Maybe wait and take your supplements mid-morning if you have a break and a snack. Often supplements sit better in the stomach if they’re taken with food, it depends on the supplement. Some supplements will upset people’s stomachs if they take them. For example, iron is a common one that will often upset the stomach if taken on an empty stomach. So maybe stop midmorning and have a snack of some fruit and some nuts or something like that and that could be a time to take your supplements, or take them with lunch. Take them maybe at a time that you’re not drinking coffee. Give yourself an hour or two in between drinking coffee and taking your supplements to maximize the absorption. You don’t want to be drinking maybe above three to four cups is probably going to reach a point where you are going to start a little bit to interfere with bone mineralization. So just be moderate with your caffeine consumption.

18:23
Dr. Maya Novak:
Great. I do have one last question in regards to calcium. When I was doing research for myself in regards to calcium and calcium supplements, I came across information and studies that were showing that calcium supplements can negatively affect the body long-term. So what is your research on calcium supplements their potential to contribute to heart disease in the long-term?

18:55
Dr. Pamela Fergusson:
Right. I mean I really would, once again, state that it’s better for us to be looking to the whole food. I don’t think we need to be taking a calcium supplement long-term. I know that was the thinking maybe 10-15 years ago, particularly women who were maybe at higher risk for osteoporosis, or elderly women, in particular, were are a group who were often prescribed supplements. Now, if you do have osteoporosis, maybe you have to balance the risks and maybe it might be wise to take calcium, magnesium, vitamin D, to help protect your bones. But you do need to balance that against the potential increased risk of heart disease. Once again, if you’re eating a plant-based diet your risk of heart disease will be decreased. So decreasing your consumption of saturated fats, animal proteins, and increasing the plant and fiber consumption will reduce your heart disease risk. If you need to take calcium supplements long-term, you can be reducing your heart-disease risk in other ways. But if your bone density is good, once you’re finished with recovering from your injury, if your bone density is good there’s not any reason to continue taking calcium supplements long-term and we don’t want to cause a situation where you end up putting yourself at risk of heart disease.

20:27
Dr. Maya Novak:
You mentioned protein. Right after calcium, there is protein. I need protein. Maybe even more protein.
Can you talk a bit about protein?

20:42
Dr. Pamela Fergusson:
Sure. When recovering from an injury, yes, you will have slightly increased protein requirements and it depends how serious the injury is. If you ended up having major surgery, for example, as a result of your injury recovery process, then yes, your protein needs will be increased fairly significantly. It could be that - the easy formula for working out about how much protein you need in a day is around one gram of protein per kilogram of body weight per day. So you just need to calculate your body weight in kilograms. So let’s say you weigh 60 kilograms, then that would mean you would need around 60 grams of protein per day, okay. Or if you’re 75 kilograms, then again, 75 grams. Now, if you have a serious injury where – particularly if you’ve had surgery or if you’ve had an injury where your body – let’s say you fell in a cycling accident and you had like a deep tissue injury from it, so, therefore, there’s a lot of tissue and muscle recovery to happen. Then yes, your protein needs may be increased, to say 1.3 grams of protein per kilogram per day. If your injury is more minor than that, maybe a minor fracture, that kind of thing, you probably don’t have much of an increase. So it depends on the seriousness of your injury. But you could increase your protein intake slightly, yes, and you definitely can do that through whole foods. You don’t need to look to a protein supplement. You can if you enjoy like a protein powder or a protein bar if you have one that you like and want to add that into your daily routine, in a smoothie or something, that’s fine. But you can also look to, again, we’re seeing more and more recommendations to choose plant-based sources of protein more often. In Canada here, we just had our National Food Guide updated and the recommendation was to choose plant-based sources more often. So I would say, again, nuts and seeds, beans and lentils, tofu – these are good choices. You should be able to meet – work that out – and you could enter in all your food into an app like Cronometer for a couple of days and just see if you’re meeting all of your protein needs. Cronometer will also highlight any other nutrition deficiencies you may have because it will show you the micronutrients, not just protein. We don’t necessarily – I mean we often say we don’t really need to worry about protein, because even increasing your protein requirements, I think as long as you’re a variety of whole foods throughout the day and you are meeting your calorie requirements, it should not be difficult to meet your protein requirements, even at this level of increased requirement. But where you might find issues are more things like zinc. We want 4to make sure we’re getting adequate zinc intake in recovery. Omega 3s, calcium – it’s more in the micronutrients that you may find that there’s an issue. So paying attention to those nutrients you may want to supplement, but always trying to look for whole food sources of those nutrients to keep your needs met.

24:35
Dr. Maya Novak:
Great. I love that you mentioned the Cronometer app. Years ago, I actually learned a lot about food through this app.

24:43
Dr. Pamela Fergusson:
Good.

24:43
Dr. Maya Novak:
It was really eye-opening to see what I was really getting into my body and its expansion and knowledge through apps like that.

25:03
Dr. Pamela Fergusson:
I was just going to say it can be fun, and I think as long as it’s fun and then entering your data into Cronometer can be a great idea. I would encourage everyone to give it a go for three for four days, that kind of thing, to learn. Then maybe dip back in again once in a while to enter. I would caution people against entering every single day. We don’t want to over-medicalize our diet. Food is also for enjoyment. It’s for living. We don’t want to have a day where we go out with friends and maybe we enjoy some pizza, some wine, whatever, and then you back and enter everything into Cronometer and oh, I exceeded my sodium for the day and then, you know. We don’t want it to become something that’s punitive or causes anxiety. But on the other hand, it may identify for you if you’re seeing on one day that you didn’t meet a certain nutrient requirement like iodine or something, well don’t worry too much about one day. But if every day you’re finding that there’s a nutrient that you’re low in, then it’s time to just Google. What are good sources of iodine? Find that out and then maybe increase that – some of those foods in your diet.

26:12
Dr. Maya Novak:
So before, you mentioned inflammation and animal protein together. So why did you say that animal protein are connected to inflammation?

26:35
Dr. Pamela Fergusson:
It’s really high intakes of animal protein. I want to be clear about that. I don’t want to have anyone panicking that they need to completely remove animal protein from their diet. I mean I have, I will be transparent about that, that I myself eat a completely plant-based diet and it’s certainly possible to do that in a very helpful way. But really, the balance is more to say that if you’re eating a high intake of animal protein, that is inflammatory. It causes chronic inflammation in the body. Now, there’s a difference between chronic inflammation and acute inflammation. Acute inflammation is actually healthy and we want that. Of course when you have an injury you will have inflammation around the injury, and actually, that’s a healthy thing because your body is trying to bring heat and nutrients to that area to help with healing. Over the long term though in our bodies when we have systemic chronic inflammation that can lead to things like heart disease, diabetes, cancer, these chronic diseases. So what we want to do is we want to support the body’s immediate healing response, but we don’t want to develop chronic inflammation in the body. High levels of animal protein do lead to chronic inflammation.

28:09
Dr. Maya Novak:
Mm-mm. That’s really good to know. So in regards to that, another supplement that a lot of people are also asking about is collagen supplements.

28:20
Dr. Pamela Fergusson:
Mm.

28:20
Dr. Maya Novak:
Is it necessary? Is it not? Especially when we’re talking soft tissue and just what is this about, collagen?

28:30
Dr. Pamela Fergusson:
The body produces natural collagen, so we don’t necessarily need to take a supplement. I think that the results of the research are somewhat mixed, whether there’s a benefit to taking an additional collagen supplement. You can boost your body’s own collagen production, through Vitamin C, particularly is useful, iron is also useful in supporting your body’s own production of collagen. So I would suggest that people consider, first of all, making sure that they’re getting adequate intake of those nutrients. Once again, looking to whole foods first, but you could consider supplements in that area, particularly if you are iron deficient. We don’t want to supplement iron if you already have – if you are iron replete – if you’re getting enough iron already in your body because iron is actually an inflammatory compound if we take too much of it. Some nutrients, as we know, like Vitamin C is a great example, you can’t really take too much, your body will just get rid. You’ll excrete any excess Vitamin C, but iron is not one of those. You will store that iron and we don’t want to have too high iron. So don’t just start taking an iron supplement, do get your doctor to do blood work and see. I recommend that everyone get bloodwork done every year if they can, and see where your iron levels are at. If your iron is low, you can then try increasing your food intake of iron, but you could also consider a short-term iron supplement to get your iron levels back up. Then I would also say with Vitamin C, the Vitamin C that you eat in whole foods is better absorbed than that that you take in supplements. Also, with Vitamin C, when you take very high doses – and we will see like very high doses sometimes available sometimes in supplement form – when you take very high doses, you absorb less of it, a smaller percentage. So if you’re eating an orange, for example, you’ll probably absorb a lot of the Vitamin C that’s in that orange. But if you take a very high dose of Vitamin C, you’ll absorb a smaller percentage of that very high dose. So more is not always more in the case of Vitamin C. But we really should have no problem if you’re able to eat fruits and vegetables, and most of us are able to at least eat some fruits and vegetables, we should have no problem in getting Vitamin C from whole foods.

31:22
Dr. Maya Novak:
We'll continue in just a moment. I wanted to quickly jump in for two things. First, thank you for tuning in. And second, I’m sure you have at least one friend, colleague, or family member who would very much appreciate this episode. So share it with them and help us spread the word. Now let’s continue…

31:43
Dr. Maya Novak:
So when you were talking before about going to whole foods whenever possible in regards to collagen – so a usual recommendation, besides pills, is grass-fed beef, then organic chicken, bone broth or gelatin powder. What is your take on these foods?

32:07
Dr. Pamela Fergusson:
Again, I think that the research is mixed. I really don’t think we have clear evidence that eating these foods actually – although they contain collagen that doesn’t necessarily mean that that collagen is being absorbed and used by our body as collagen. We need to be stimulating our own collagen production for the most efficient healing. So I think, as I say, the evidence is mixed. I’m not sure that we have evidence of harm in taking those products, at least in smaller quantities, but we don’t want to reach a point where we’re taking very high intakes of those products, particularly coming back to the issue about high intakes of animal proteins, or saturated fats, that kind of thing that comes with those products.

33:03
Dr. Maya Novak:
So before, you briefly mentioned Omega 3 fatty acids. It’s the same as with calcium and dairy, usually, Omega 3 is connected to fish and when we are injured it’s like yes, I should be eating more fish or I should add fish oil supplements. Can you talk a bit about Omega 3 fatty acids, in regards to supplements and food choices?

33:30
Dr. Pamela Fergusson:
Sure. So actually, Omega 3 fatty acids, they are found in fatty fish, but the fish themselves are not producing those Omega 3s. It’s not that salmon produces Omega 3 fatty acids. Actually, they are just storing those Omega 3s in their tissues after they eat plants that are available in the sea, in lakes, or in rivers. So we can also look to sea plants for Omega 3, like a seaweed salad or those kinds of things, but it might be easier to get Omega 3s from a supplement if you’re looking EPA and DHA. You can find some supplements that are sourced from sea vegetables in order to get the EPA and DHA. If you’re looking for ALA, which is another Omega 3 and is available from things like walnuts, ground flax seed and that kind of thing, then that’s relatively easy to get from plants. Fish are a source of Omega 3s, absolutely, but we don’t need to look to fish. We can look to the plants. Just as the salmon is eating the plant, we as humans can also eat the plants ourselves.

34:48
Dr. Maya Novak:
So is it important that we then add, for example, fish oil supplements when we are injured, or not?

34:58
Dr. Pamela Fergusson:
Omega 3s are anti-inflammatory. They’re part of an overall - and I want us to really be thinking overall about our approach to our diet and our lifestyle and taking an anti-inflammatory approach. Coming back to what you said at the start, to activate our body’s own healing mechanism. So yes, potentially Omega 3 supplements can be beneficial to us in reducing the inflammation in our body in general. But once again, food sources are more effective than supplement sources in this case and remembering that removing inflammatory parts of our diet is just as important as adding in healthy foods and supplements. I would take it a step further to say that it’s not only really about food. Inflammation in our body is also about stress and when we’re injured, a lot of people are experiencing a lot of stress. Is this injury going to go away? Am I going to return to the healthy function that I had before? Now all of a sudden all of the things in my life are much more complicated. Just caring for my family, trying to continue with my work, my economic responsibilities are stressful, or maybe my family is having to care for me and that’s very stressful as well. It can be hard on a relationship. These things can contribute to stress. Another issue is sleep. Sleep is very important in reducing inflammation in the body, however, when we’re injured it can be difficult to get long periods of sleep. You may need to wake in the night to take medication for pain relief, or your pain may just wake you in the night. You might not be able to find a comfortable sleeping position and so you may be experiencing restless sleeping even when you are asleep. So sleep, trying to find ways to sleep throughout the day, getting naps or whatever, it pays to get that sleep in to help the recovery happen, to help the rest happen. Meditation may be useful at this time, and surrounding yourself with people who are supportive of your recovery and are supportive of your recovery plan. So not always suggesting something new or something different, but are respectful of the fact that you have taken the time with your health and professional team to come up with a plan and they’re looking for what they can do to help you and support your healing rather than maybe adding more stress. So looking for people in your life and sometimes it changes. The people that are your best friends, who are the best people to be with you when you’re healthy, may not actually be the best people to surround you with when you’re recovering. So keeping that in mind as well. You need to be thinking holistically about this. It’s not only – and then finally I would say about purpose in life, thinking about your identity and your purpose. We still need to feel useful, we still need to feel loved, important, and connected. Those are, I think, just as important to reducing inflammation as is what we eat.

37:34
Dr. Maya Novak:
Pamela, I love what you just mentioned because it’s so extremely important. When we are injured, when people are injured, a lot of the time we feel like we’re a burden to our family and we should be doing something. A lot of the times, I say that this recovery right now is your job. This is your main priority and you have to take care of yourself. It’s also a practice in receiving the help that you need. It’s not just feeling like you need to do something, and I’m noticing especially with women that they are real givers.

39:16
Dr. Pamela Fergusson:
Yes.

39:16
Dr. Maya Novak:
They are taking care of everybody and then something happens and it’s just really hard for them to receive that help. So you are actually really athletic. You are really active. You are a runner, you are a speed walker, you’ve completed five half marathons, one marathon, two ultramarathons, and one ironman - so you are pretty active. Have you ever been injured, like seriously injured?

39:45
Dr. Pamela Fergusson:
Yes. Well, I have a chronic injury that I’ve had since – oh, I don’t know – I’ve probably had it for about 15 years. It’s an IT band that will flare up and make it very difficult it run. I’ve done many different things – chiropractor, osteopath, physiotherapy, strengthening exercises. I’ve done steroid injections a couple of times. I didn’t keep doing that, but I did try that. I’ve done lots of different things to try. I’ve also modified what I do. So I often will speed walk now instead of always running. I’ll do cross training as well. I have to – I really do need to get up every morning and do a bit of yoga, otherwise it flares up. So I need to keep my flexibility in order to stop that injury from flaring up. I actually had a flare up just a few weeks ago. I wasn’t being as conscious as I could have been with my morning stretching and I had a flare-up. So, you know even when you’re doing everything that you can with your diet and being very healthy, can you still absolutely face injury. So I would just say – and this is only my own experience – but I would just say that I don’t really feel that it’s affected my quality of life very much. I’ve just adapted. I’ve maybe changed my activity patterns. I’ve done more swimming. I’ve done more yoga. That kind of thing in order to still have an active and full life, even if I maybe don’t run the same number of miles I used to.

41:37
Dr. Maya Novak:
Yeah, and what you said is so true. We are really scared of changes and when something stops it’s like well, my life is over. But you just change your life so that you can still have a full life. It doesn’t mean if you have an injury that that’s it. That’s there no light at the end of the tunnel.

41:58
Dr. Pamela Fergusson:
Of course. That’s right. We don’t need to think that there’s only one way of being happy.

42:06
Dr. Maya Novak:
Yeah, true. So going back to supplements, another one that I would love to explore with you is cannabis oil. It became really popular a few years ago, and it’s becoming more and more popular. When it comes to healing and when it comes, for example, to managing pain, what do you think about cannabis oil?

42:33
Dr. Pamela Fergusson:
Yes, I think that it actually has a wonderful potential to help with healing. I think that people should work with a practitioner that is very knowledgeable to make sure that they’re choosing the right oils that are beneficial for them. There are definitely oils out there where you’re not going to experience the high associated with cannabis, but you can still experience the soothing pain control benefits. There are different ways of taking it. You don’t need to smoke it. You could just take it under the tongue. You could take it in an edible like baked into a cookie or something like that. So there are many different ways of being able to experience this. I think just work with a practitioner who is knowledgeable and is able to help you with achieving the right dosing and also the right product for you.

43:37
Dr. Maya Novak:
Can there be any negative effects of cannabis?

43:45
Dr. Pamela Fergusson:
Well, I suppose some people would be concerned, like any pain relief, with becoming dependent on it long term. So I think that’s something just to be conscious of. I think that there is a time in our lives sometimes where pain relief is useful and as long as it is fitting into your life in a way that is helping you thrive, then I think there’s nothing wrong with continuing it. I just think we want to make sure that it is continuing to serve you, and not be something that you end up serving.

44:25
Dr. Maya Novak:
Yes. So true. So if we are talking supplements, is there a difference? Is it important what kind of supplements we are choosing? So is there a difference between, for example, organic versus bio versus synthetic? Is this important or not?

44:43
Dr. Pamela Fergusson:
Well, I think sometimes the bio supplement may be slightly better absorbed, similar to the absorption from a whole food. But the vast majority of supplements really are synthetic. It’s harder to find supplements that are going to be coming from whole foods, like bio supplements. If you can afford the organic supplements and they’re available to you, then that’s great. Not all supplements are available in organic format, but if you’re able to then that’s wonderful, but I just really can’t emphasize enough how much it’s important to look to whole foods rather than only supplements.

45:27
Dr. Maya Novak:
So talking about whole foods, and everything that you explained here, let’s say that an injured person decides to change their diet, to go to whole foods, to be more on the healthier side, for example. But, they are injured – seriously injured – so they actually cannot take care of themselves, so they rely on other people. How can you take your family or get them on board to support you so that you can also support yourself in regards to foods? Is there any trick that people can do so that this transition is easier, but also helps the family understand why this is so important for you?

46:15
Dr. Pamela Fergusson:
I think that you need to take a look at what your family is doing for you, and just make sure that your expectations are realistic as well, right. Because if you have a partner perhaps – maybe you have a partner, you have a house to manage, you have children, and suddenly now there is the additional care required of helping to support you. Your partner may be very happy to help you and want to help you, but there are limitations of course. Time, money, exhaustion comes into play after a while and it can stress the relationship. So look for things that are simple, clear, and easy. Maybe try to speak with your healthcare team and really know what it is that you want before asking your partner to do things. Or even maybe try to involve your partner in some of those sessions so that your partner can better understand what it is that you need. Things like supplements are usually relatively easy to do. It’s just a matter of buying the supplements. You can even maybe order them online yourself from your phone rather than expecting that your partner drives to the shop to pick them up for you, but supplements are relatively easy. If you’re looking to transition your diet to a new way of eating, that’s a bigger change. Maybe if you are the person who does more of the cooking and now you’re injured and you’re not really able to cook. Now your partner is suddenly cooking, and now maybe you also want changes in your diet at the same time. So they may be a little bit overwhelmed. This is a time to think of simple things – soups, smoothies, fresh raw foods. Really, these are going to be some of the healthiest things for you anyway. And there may be some of those things that you are able to actually do. If you are able to make a list of what you need, you might be able to manage after some time of recovery, being able to get to the kitchen and make a soup or a smoothie for yourself. If you have a high-powered blender you can even make soup right there in the blender just by leaving it running for a while, it will heat the food. So these kinds of things you might be able to do yourself, but I would encourage you to work with your partner and find out what is realistic. Maybe even get them onboard with the idea that this could be healthy not only for you but healthy for the whole family. And idea like transitioning to eating more plant foods is something that will almost invariably be healthy for everyone in the family. Maybe you could watch a documentary together like Forks Over Knives, something like that. Get them on board with the idea that this kind of thing could be healthy for them as well, and healthy for the children, or for the parents, or grandparents, or whoever else is living in the household with you. So making them see the benefit and just try to keep it as simple as possible and keep your expectations realistic. Look at family resources. Is there someone else? A friend, for example, who might be able to help. I don’t know if you have this where you live, but I know that here in Canada, I’ve been involved a few times in something called Meal Train. That’s a – I believe there’s app, but there’s also a website and when someone is injured or maybe if there has been a bereavement in family or something, someone will post Meal Train and the people will say the type of food that they would benefit from and then people can sign up to bring something. So you can list that I’m looking for plant-based meals that contain lots of leafy green vegetables, or you could say I’m looking for things that can be easily frozen, or I’m looking for snacks, like energy balls, that kind of thing. Then people can make those things and what they do, you just sign up for a date and time and then you bring it by. I’ve done – I’ve brought food a few times on these type of Meal Trains, sometimes to people I didn’t even know personally, but someone that I knew, like a friend of a friend, shared this need and so I signed up for it. So look to your community for resources and this could be a time, if you’re financially able to, to mobilize a little bit of resources behind this period of time and your recovery. Whether that means paying someone to come in the house and help maybe with the laundry or vacuuming or some of those heavier chores that you’re not able to help with. Or maybe it’s a time to buy a meal delivery service, like a healthy meal delivery service that can provide a few meals a week just to take the pressure off. So these are different creative ideas. Maybe this is a time if you have family close by who could come, help with childcare, or any different way. They don’t necessarily only need to be cooking. There are different things that they could be doing maybe that would be useful to help take some of the pressure off your household.

51:32
Dr. Maya Novak:
Wow, I love these suggestions, and I’ve never heard of the Meal Train before, but it’s such a great way. Because sometimes we don’t live near family and when you’re injured, you are all of a sudden completely alone. So it’s really like extra help and so beneficial and it also gets you in contact with another human being.

52:00
Dr. Pamela Fergusson:
Yes, absolutely. Yeah, and it’s lovely to feel cared for. Sometimes that’s the biggest work is just allowing yourself to be cared for. Generally speaking, when someone’s injured, people want to help. So think of very practical ideas of what you need. Create – and you might get inundated with a lot of requests – how can I help, what can I do. I had a very good friend who was injured badly in a cycling accident a year ago, and he and his partner prepared like a Google doc that they shared the link for, and here was a list of everything that they said that would be helpful, right. So there were, I think, like food donations, or there was a list anyway. I can’t even remember everything that they listed, but just whatever resonates for you, maybe put it on a list. Then it’s not demanding at all. If someone says is there anything I can do, you can say well, you know, we’ve prepared this Google doc, I’ll share the link with you. If there’s anything on there that might be useful. Maybe try, just like with a wedding registry, try to think of some things that are a little bit smaller and other things that are maybe bigger, because people have different capacity and ability to help. Some people might want to just support financially, and some people may want to support with their time.

53:26
Dr. Maya Novak:
Wow, this is so great, having this kind of document. I’m sure that many listeners are finding this so helpful. I’ve never done something like that but being prepared, having something written and then send it out. Because when we are in a really low state, or in sadness or anxiety, it’s really also harder to explain what you need. But if it’s already written, you can just send the link.

53:58
Dr. Pamela Fergusson:
That’s right.

53:59
Dr. Maya Novak:
It’s there. If you can help that would be really good.

54:01
Dr. Pamela Fergusson:
Yes.

54:01
Dr. Maya Novak:
So when you were mentioning the medical team or the recovery team that a person has, and if we are talking about food and diet choices, or even supplements, is it important for the person to work with, for example, someone like with you, with a registered dietician, with a nutritionist? Can they get all of this information at their doctor’s office?

54:29
Dr. Pamela Fergusson:
I think in terms of nutrition I would advocate for the idea that a registered dietician is going to be the nutrition expert that’s going to be helpful to you. Some doctors have training in nutrition, but many really do not. So I would encourage you, if you’re able to, to consider including a registered dietician in your team.

54:51
Dr. Maya Novak:
When we are injured, and especially seriously injured, you mentioned medication - this can be everything from antibiotics to pain killers to everything else. And when you are taking this medication it definitely has an effect on our gut and microbiome. How do we take care of this and is it important to take care of that flora?

55:19
Dr. Pamela Fergusson:
Absolutely. So I would say your doctor may also prescribe a probiotic that goes along with an antibiotic, and follow your doctor’s advice about this. But really, it’s more after you finish the antibiotic that you’re going to need the probiotic to help you to rebuild your gut flora. Don’t forget also that your gut flora actually feeds on fiber. So you need a fiber-rich diet to go along with that. Many people don’t realize that even if you’re taking a pill or a liquid that will say oh, it has a million or a billion live cultures, if you take that and it goes into your gut those, unfortunately, can die if they don’t have food. They’re alive, they need food, and what they feed on is fiber. So you need to be eating fiber. You already have millions, billions of bacteria in your gut, and you want to be feeding it with healthy fiber so that you continue to support those good bacteria growing in your cut. So absolutely, a probiotic can be useful but support your diet also with fiber.

56:31
Dr. Maya Novak:
And fiber – just to recap – is found only in plants, not in animals.

56:36
Dr. Pamela Fergusson:
Only in plants. That’s right, yes.

56:38
Dr. Maya Novak:
So you cannot get it from meat, or dairy or eggs, or anything like that.

56:42
Dr. Pamela Fergusson:
That’s right.

56:44
Dr. Maya Novak:
Okay. So fruits and vegetables are your friends because your microbiome is going to be super happy because of that.

56:48
Dr. Pamela Fergusson:
That’s right, yes.

56:50
Dr. Maya Novak:
So are there any other nutrients? I know that we covered a lot already, but are there any other nutrients that are important when it comes to healing from an injury?

57:04
Dr. Pamela Fergusson:
Zinc is an important one, let’s not forget about zinc. Omega 3s potentially, calcium as we talked about, protein as we talked about, and I think that’s mostly it. Also, if you’re iron deficient, you may want to consider an iron supplement or just making sure that you’re getting iron-rich foods.

57:26
Dr. Maya Novak:
So, when we’re talking about iron, iron is often connected to red meat. If you’re talking about getting nutrients from food – is then red meat a good source of iron and taking care of the body?

57:45
Dr. Pamela Fergusson:
It is a source of iron, no doubt, but we can also look to plants. So it’s really lentils, it’s beans and seeds and greens that are going to be your best sources of iron - lentils, beans, nuts and seed, and greens.

58:04
Dr. Maya Novak:
And if I’m correct, it’s also really important to eat Vitamin C foods with them.

58:08
Dr. Pamela Fergusson:
That’s right – foods rich in Vitamin C will help you to absorb that plant-based iron, yes.

58:14
Dr. Maya Novak:
Perfect. You said that you had this injury 15 years ago and you are still healing, or if you are not careful, it flares up.

58:31
Dr. Pamela Fergusson:
Yes.

58:31
Dr. Maya Novak:
So what is your number one advice to someone who is injured? What would you suggest to someone, what would you tell them to do that is absolutely important, and then take care of the rest?

58:48
Dr. Pamela Fergusson:
The number one thing I would say to someone who is injured and they’re looking to recover – the number one thing I would say is to not lose hope really. That is the most important thing is to keep your hope and to keep optimistic and to not necessarily – when I say don’t lose hope – you don’t have to cling to exactly the life you had before the injury, but you have to believe in the idea that new opportunities are going to open up. Things you maybe didn’t even realize could be exciting for you and that life will continue to be rewarding and fulfilling. That recovery will come in ways that maybe you don’t even expect, and you have to be open to that healing and believe in your body’s capability to do so. That hope is the most important thing.

59:48
Dr. Maya Novak:
I love this. Let’s say that someone right now is really at a low point and because it’s taking so long, they’re actually losing hope. What would you say to someone who really connot see the light at the end of the tunnel?

1:06:23
Dr. Pamela Fergusson:
Well, I would encourage them to try to look holistically throughout their life and look for things that are still sparking joy in their life. Even maybe start with a practice of meditation and a gratitude journal in the morning when they’re waking up. Just think of anything that is bright. Even if you’re confined to bed, you know, what is your view from your window? And if you don’t have a nice view from your window, can you find a piece of art that you enjoy and hang it on the wall? Can you get a family photo that you enjoy? Can you Skype with a friend or relative that brings joy into your life? Can you find a wonderful book that you enjoy that you can read? Find things that spark joy in your life that don’t always have to relate specifically to your recovery. Find ways that your life can be fulfilling along with the recovery, or even in the midst of the recovery process. Life doesn’t have to just begin once you are able to be fully recovered because your life after your recovery may look different. Especially if this is a major injury and especially if it’s taking a long time to heal. Your life after the injury may look different than it was before, and that’s okay. Change is part of life. This is an unexpected change. It’s just like with children – when you have children, of course, your life is forever changed, but you expected that at least to some extent. Maybe some of us are surprised, but you have at least nine months to prepare for it so it’s a planned change. It’s a big change, but it’s a planned change or it’s a known change. Injury is usually an unknown change and it’s usually an unwelcome change, and that’s part of what the whole problem is. This is a change we don’t have control over and I think that’s what we need to recognize is that some of this pain that we’re feeling mentally is coming from our own resistance to change.

01:02:05
Dr. Maya Novak:
Beautiful, and not forgetting that people are absolutely not alone.

01:02:11
Dr. Pamela Fergusson:
That’s right.

01:02:11
Dr. Maya Novak:
There is always someone who can help them.

01:02:15
Dr. Pamela Fergusson:
Yes, there are online forums as well. I’ve never sought an online forum for pain management or injury recovery, but I have looked – I’m very open about the fact, for example, that I had five miscarriages before becoming pregnant successfully for the first time. During that time, I did seek the support of other women who also had experienced miscarriage because it was something that, in that time, I felt really other people who hadn’t experienced it didn’t quite understand and they might say things that would hurt me and things, so I sought a community online. So that’s something that I’m sure exists within the injury recovery space and pain management, chronic pain management. So turning to online support may perhaps be useful. Blogging about your experience if you’re a person who likes to share, that may also be helpful for you.

01:03:20
Dr. Maya Novak:
I love what you just said because this is also how I started, and it was just something that I had to give out, but then people started contacting me and I realized that sharing my story helped so many others.

01:03:33
Dr. Pamela Fergusson:
That’s right.

01:03:34
Dr. Maya Novak:
It can be really – at the end – that turning point, that huge change can actually be a blessing in disguise.

01:03:47
Dr. Pamela Fergusson:
Exactly, yes. That’s absolutely right.

01:03:50
Dr. Maya Novak:
So I have one last really fun question. If you were stuck on a desert island with an injury and could bring only one thing to help you recover perfectly, what would that be?

01:04:06
Dr. Pamela Fergusson:
It would definitely be my partner because, you know, to try to recover alone is just much, much more difficult. So to have someone there to give you hope. I even think of the movie Castaway, I don’t know if you’ve seen that, but he creates a person out of a volleyball, right. Makes hair on it and everything because as humans, we need that human connection and that sparks hope. It’s a reason to go on and also another person will bring their own mental energy, ideas, and thoughts. When you are down, maybe they’ll be up. So having someone in your life, whether it’s your partner, a family member, a child, someone that you can reach out to, connect with, and feel that human connection. I think that’s the most important thing.

01:04:56
Dr. Maya Novak:
Beautiful. Pamela, I’m sure that people would love to know more about you, or reach out to you, or make a plan with you for their injuries. Can you share please where people can find you, and how they can work with you if they’re interested in this?

01:05:12
Dr. Pamela Fergusson:
Sure. So you can find me at my website, which is pamelafergusson.com or you can find me on Facebook at Dr. Pamela RD, or you can find me on Instagram @drpamela.rd.

01:05:33
Dr. Maya Novak:
Perfect. Pamela, that was so, so great. I really enjoyed our conversation. Thank you for being here and thank you for sharing your knowledge, and thank you for helping so many injured people around the world.

01:05:47
Dr. Pamela Fergusson:
Thank you. Thanks for the opportunity.

01:05:51
Dr. Maya Novak:
Thank you for tuning into today’s episode with Dr. Pamela Fergusson. If you haven’t done it yet, subscribe to the podcast on whatever platform you’re using to tune in, and share it with your loved ones – yes, I’m thanking you in advance, and as always, with a cherry on top. To access show notes, links, and transcript of today’s episode go to mayanovak.com/podcast. To learn more about The Mindful Injury Recovery Method visit my website mayanovak.com and find my book Heal Beyond Expectations on Amazon. Until next time – keep evolving, blooming, and healing.